A new twist in my dry eye ordeal.

[vivian3090]

Hey everyone! I know it has been quite a while since I have posted on here, but things have been just crazy and busy.
I did want to take the time to update everyone about my situation and maybe y'all could help me with a few questions.

The symptoms of my dry eyes have gotten a bit worse over the past few months, it's been frustrating b/c I have been having other health problems along with my dry eyes.

I live in the Dallas/Fort Worth area and I finally traveled to Houston, Texas to see Dr. Richard Yee. I honestly didn't know what to expect from seeing him. Part of me was ready for him to just tell me what all the other doctors have told me and part of me was hoping he'd find something else and hopefully have a way for me to find relief from the pain and discomfort I get from my eyes.

When his nurses first took me in they checked my vision and did the schirmers test.
-I can see beyond perfect according to the machine that measures your eyes (I am not sure what it's called, but its the machine where you look in and see a barn...)
- But when I do a vision test, what I should be seeing clear is all blurry. (And originally we all thought it was due to how dry my eyes were dry)
-They also tested my eye pressure, it was good 10 and 11.
-The schirmers test told us that my left eye is a 2 and my right eye is a 6. Which I can see that b/c I have always told everyone my left eye has always been the one that has cause me more pain and discomfort.

So it's pretty obvious to them right off that bat I have a bad case of dry eyes just based on the schirmer's test. But then Dr. Yee comes in and right off the bat he is very nice and comforting. He also found somethings going on that the other doctors have failed to catch.

-He quickly noticed my Meibomian glands were blocked, and when he pushed on them it wasn't clear oil, but some white gunk. So I now am diagnosed with meibomian gland blepharitis. I will say that I have been asking again and again to my doctors in Dallas about this condition, and they ASSURED me I had no such thing, it's just amazing how Dr. Yee saw right off the bat about my bleph. He said I have it pretty bad, so the damage done by lasik and the condition of my bleph has made me like the perfect storm of dry eye.

-They also put dye in my eyes so he could see the extent of the damage that the Lasik has done to my eye, and judging from his comments and my boyfriends reactions (they had a camera pointed on my eyes so everyone in the room was able to see it) the damage is pretty bad. This is also surprising because every doctor has told me my eyes have healed "perfectly" and there doesn't seem to be any extensive damage. But not according to Dr. Yee!

-One final observations he noticed was that the tissue on my eye ball is very badly wrinkled. He told me that my eyeball is supposed to be completely smooth, but the tissue on my eye wrinkles so much, like "wrinkled bed linen" he described that my eyes were so dry that my eyelids are like "windshield wipers" and over the course of my dry eye battle, the eyelids have been stretching out the tissue in my eyes. Dr. Yee said that the wrinkles on the eyes can be the cause of a lot of my discomfort as well. I forgot what he called it, but I want to assume its similar to macular pucker.

So after he looked at my eyes he gave me the plan of action, he feels that he can take me from a 10 to a 5.....he feels confident that eventually he can get me down to about a 2/1...but only time will tell.

I am currently doing this now with Dr. Yee's instruction:
-Restatsis 3x a day
-Serum drops 4x or more a day
-Dapsone 4x a day.

(Dapsone is a compounding eye drop that he has specifically invented. It is supposed to help inflammation, kind of like steroid drops without the risks of glaucoma and other effects of using a steroid for longer periods. I will say that it has been effective in helping the inflammation, but it doesn't last as long as steroid do. I really do have to put it in 4x a day, I would put it in more if I could afford to have two bottles made every month!)

-HydroEye 4 tablets a day
-He also wants me to do the 9 hard blinks 3 times a day to help with the oil flow.
-I also got my lower ducts cauterized.
-He also suggested I get lipiflow, but as of right now I am not sure because of how much it costs and also because I have read some of the stories on here and most of them haven't been really happy with the results. So I am actually going to try to make up for this a little bit by doing warm compresses....I am just scared because I don't want to cause infections and other problems by applying so much heat around my eyes. So if any suggestions about how to warm compress would be greatly appreciated!
-He also says that later on I can get surgery to correct the wrinkles on my eyes. I am strongly considering this since it is covered by insurance, but this would be a last resort type of thing.

So that is my plan of action for a few months. Now that we have found that it's not just dry eye from lasik, but also from meibomian bleph and the wrinkles in my eyes, and now that I am getting some of the right treatment, I have a bit more hope that I will be able to find relief. Not a cure, but relief. I hope I wont have to put drops in my eyes every few minutes, I just hope my standard of living will improve a bit more, the more I continue with Dr. Yee's course of action for me.

But with this comes a lot of anger towards my doctors in Dallas. How did they not catch my bleph, even after I have asked them to check for it. I remember asking my doctor who was doing my lasik consultation to make sure I didn't have bleph and he assured me I didn't have anything and that my eyes were completely healthy and under control. Even after the surgery and I started having more problems, I asked them to look into bleph. They looked and assured me some more that I didn't have it. It makes me wonder how differenent it would have been if they werent so blinded by money and caught my bleph before lasik. And if they did catch it after lasik, would I be in this much pain and discomfort? I almost want to move down to Houston so I can be near Dr. Yee because he has been the only one who has truly took the time to listen and look into why my eyes are so dry.

But what's done is done, I can only remain hopeful that I will one day find more relief from this condition. Trying to keep positive! I definitely am glad I took the trip to Houston to see Dr. Yee. I would highly recommend any of my other texas sufferers to go see him. The Dapsone eye drops that he makes may help you find some relief!!

[kylix]

maybe you could try in the future Prokera, I think one of the potentially best properties of AM is that it helps reduce scar tissue if it's what you call wrinkles.
Moreover in Huston there is Dr. Panzer who could tell you whether it could help you or not: http://www.myfoxhouston.com/story/19...type=printable

[patientpatrick]

Hi Vivian,

In regards to your mebomian gland dysfunction, I've found that about a cup and a half of rice in a nylon stocking tied up works very well for a warm compress. In fact it's been better and cheaper than any of the ones I've purchased. The trick I've found is that once you fill the stocking twist it half way in the middle so that it make 2 small balls of rice. I heat it in the microwave for about 45 sec. Wait about a min then another 25, that way I don't cook the rice. I've been compressing 3x a day for 15-20 min then massaging my lids afterwards. Every 3 days or so I express them with a mastrota paddle and q tip. This regiment has been the best treatment for my mgd so far and has close to doubled my TBUT.

In regards to your wrinkles are they striae (lasik flap wrinkles) or something else? I have some striae and my doc said it could be one of the reasons why when I look at lights at night it looks like fireworks around them.

[vivian3090]

Patrick,
I will definitely try it. Is there anything advice you can give about hygiene wise? I have read stories on here about they feel that using the warm compresses made them more prone to infections, or the glands somehow have gotten clogged and caused styes?

I am going to have to call the doctor back next week because i want to find out what he officially calls it so I can better understand it. but it's not the lasik wrinkles, it's happening on my entire eye. right were my lids meet the eyeball. Its hard to explain, but once I call him I will report back to the site and let y'all know.

I am also worried that my ducts have maybe open back up? But then again I am not sure what cauterized ducts are supposed to look like....I do see my ducts are open but I dont know if they really are??

[patientpatrick]

Hygiene wise I've found that ocusoft foam works great for me. I do it once in the morning and once in the evening. Wash the edges of my lids after my compresses, expressions and massage. Are your upper puncta plugged? How is your cautery going? I'm considering it but I'm wary, it's permanent and one of my docs is concerned that because of the location of my puncta it may alter the shape of my lids as well as cause further inflammation. Good luck with everything.

[DCRdryeye]

I haven't been very diligent with my lid hygiene lately. I use SteriLid and find it's good, but expensive and doesn't last long if using daily. In terms of cautery, an ophthalmologist suggested he could 'partially' close my punctums so it's not a permanent close. My punctums are extra large from DCR surgery and thus draining too much tears out and no plug will fit them. He said once they are smaller, we can insert plugs. I'm much more comfortable with partial closer than permanent via cautery.

[Anthony16]

Yes,I have found warm compresses /lid hygiene make my ocular rosacea worse so I stopped doing them which has helped.This Dapsone drop sounds interesting

Patrick,
I will definitely try it. Is there anything advice you can give about hygiene wise? I have read stories on here about they feel that using the warm compresses made them more prone to infections, or the glands somehow have gotten clogged and caused styes?

I am going to have to call the doctor back next week because i want to find out what he officially calls it so I can better understand it. but it's not the lasik wrinkles, it's happening on my entire eye. right were my lids meet the eyeball. Its hard to explain, but once I call him I will report back to the site and let y'all know.

I am also worried that my ducts have maybe open back up? But then again I am not sure what cauterized ducts are supposed to look like....I do see my ducts are open but I dont know if they really are??

[indrep]

Vivian, The excess tissue he discussed is conjunctivochalsis.

[NotADryEye]

If you have conjunctivochalasis, and you want relief because you are symptomatic, the best solution is surgery. I had it in both eyes. Dr. ****** did the surgery, amniotic membrane transplants, posterior and anterior. The surgeries were about 1 month apart. The outcome was very good with no complications due to surgery. The chalasis symptoms are completely gone.

[No tears in ATL]

Vivian, so sorry to hear all this has happened. I remember your posts awhile back and I know you were feeling just terrible. I am relieved that you found a nice doc that seems to know what the problem is. It sounds like you are getting on the right track with this one.

[vivian3090]

Hygiene wise I've found that ocusoft foam works great for me. I do it once in the morning and once in the evening. Wash the edges of my lids after my compresses, expressions and massage. Are your upper puncta plugged? How is your cautery going? I'm considering it but I'm wary, it's permanent and one of my docs is concerned that because of the location of my puncta it may alter the shape of my lids as well as cause further inflammation. Good luck with everything.

I will look into occusoft. I have still yet to try the warm compresses...It's a sorry excuse, but with my full-time job and going to school, I have been non-stop doing those...I feel like I barely get time to sleep! But once school settles down I will definitely work on my clogged up oil glands....Things actually seem to be go "ok"... I feel like i have gone from a 10 to a bout a 9 in the past few days...maybe the hydro-eye pills are working...but it could also be due to enviromental factors as well.

And yes I got my upper puncta plugged back in May I believe....they are the ones that go right into the duct so you cannot see it, so there is no way I would know if they are still in...they last 6 months supposedly. I assume my cautery is going well, I cannot tell if they are still closed or have opened up! I am not sure what a cauterized tear duct is supposed to look like. They only reason I am unsure about it, it b/c i still see little openings of the ducts, but I was told when they cauterize, they kinda of go into the duct itself. I have been playing phone tag with Dr. Yee's nurses, so i haven't gotten an answer yet! If your doctor is concerned about it, then I would definitely heed caution with it. Thank you, I will try to keep the forum updated from time to time, this is my senior year of college and I cannot slack now!

[vivian3090]

I haven't been very diligent with my lid hygiene lately. I use SteriLid and find it's good, but expensive and doesn't last long if using daily. In terms of cautery, an ophthalmologist suggested he could 'partially' close my punctums so it's not a permanent close. My punctums are extra large from DCR surgery and thus draining too much tears out and no plug will fit them. He said once they are smaller, we can insert plugs. I'm much more comfortable with partial closer than permanent via cautery.

I will look into sterilid as well! Thank you! I have never heard of partially closed! But that sounds interesting! I have heard different arguements about wether cautery is permament or not...I get so confused, but so far (fingers crossed) with my cautery (if they are still closed, I cannot tell!) and the regime Dr. yee has put me on I seem to have gone from a 10 to a 9! But like I was telling patrick, it could have something to do with the weather as well!

[vivian3090]

Yes,I have found warm compresses /lid hygiene make my ocular rosacea worse so I stopped doing them which has helped.This Dapsone drop sounds interesting

That's awesome to hear, I am hopeful that once I start my lid compresses I will see more relief! And the dapsone seems to really help!! My eyes will go from red and irritated to almost white; I think the only pitfall is that the effect doesn't last as long as steroid drops do. BUT my left eye is VERY bad (schirmers test was a 2). I will also add that the effectiveness of the Dapsone for me has been also dependent on what activities I am doing that day. If I am at work and have to be in a situation where I cannot put my regular thera tears drops in when I need to, my eyes get super irritated again; but if I have an easy day my eyes don't get irritated till night time. I think for people who experience irritation, but don't have it as bad as my eyes; that they will GREATLY benefit from Dapsone eye drops, because i think in minor dry eye cases it's going to help with that irritation without the serious side effects (glaucoma, etc). It helps in bad dry eye cases like mine, but the effects (for me at least) are as long lasting as steroid, but it's a lot safer because it's not a steroid.

I use the dapsone drops 4x a day. It costs me about 64 dollars (including shipping and handling since it's only made in Houston TX) for a month supply. The price sucks, but it has been helping me get through my days, so it's worth it.

I would highly suggest anyone in living in Texas to see Dr. Yee in Houston.

[vivian3090]

Vivian, The excess tissue he discussed is conjunctivochalsis.

If you have conjunctivochalasis, and you want relief because you are symptomatic, the best solution is surgery. I had it in both eyes. Dr. ****** did the surgery, amniotic membrane transplants, posterior and anterior. The surgeries were about 1 month apart. The outcome was very good with no complications due to surgery. The chalasis symptoms are completely gone.

Holy Moly! You guys are right! Dr. Yee was only saying "chalasis" when I was in the room, that's why I was so confused...I knew the word I was looking for has a "k" or a "ch" sound!

I do feel the best solution would be surgery to correct his since I cannot afford the lipiflow (and b/c I have seen on here that it's not that effective), and I think this surgery may be covered by insurance.... I have hopes that this will alleviate a lot of the irriatation and blurriness I experience. I don't think I will get the surgery till I am done with school though.

I am scared of the risks of the surgery. I will talk about it to the doctors when I am ready, but did Dr. ****** tell you that there is a possibility that a surgery like that could make the dryness and the eye worse? Is it damaging nerves like it does with lasik? That's one thing I am scared about, that doing the surgery will make my problems worse rather than help. Thankfully you didn't have any complications, but where you told there was a risk?

And also, how long was the recovery time after each procedure? Were you able to carry of with daily activities? Another worry is not being able to work for a certain time due to the surgery.

[vivian3090]

Vivian, so sorry to hear all this has happened. I remember your posts awhile back and I know you were feeling just terrible. I am relieved that you found a nice doc that seems to know what the problem is. It sounds like you are getting on the right track with this one.

Thank you so much, I have high hopes that I will eventually get on a more comfortable level than I have been.

I am still experiencing some problems, I hope that once this is all through I won't have to wear the Tranquileyes anymore, I dont know if you read any of my posts regarding my experience with them, but I think I am allergic to the foam. So I have been trying to figure out way to prevent the foam from touching the skin in certain spots so they don't break out in red splotches... it's aggrivating and frustrating. Why does something that helps, cause more problems?! And also, I think the fact that the goggles are on my face and "rubbing" against my eye brows have caused them to thin pretty badly, ecspcially on the outer part of my eyebrows. I try to combat this by applying eyebrow serum before I put the goggles on, it SEEMS to help, but I don't know if I am imagininig...it seem that my eyebrows will grow back, and then hairs will fall out again. As of right now, I feel like I need to use the tranquileyes because of how well they keep my eyes hyrdrated at night, I have noticed a difference in my comfort level when I don't use them. It's a constant struggle figuring out if I want to deal with the uncomfortableness of my eyes or the red patches and eyebrow loss that may pop up due to whatever is causing the reaction..

So I really hope I can get on a level of good comfort so I don't have wear those things! I do have a spare onyx silicon sheild on hand, that I actually used for a nap the other day instead of the goggles. I was fairly suprised that i didnt have irritated eyes after using it...so progress there?? Now I just hope the onyx doesnt break after a month of use like it has done to me a few times before!