Pilot With Dry Eye

[dryeyepilot]

I'd like to start out by introducing myself. As the title and my name suggest, I'm a pilot suffering from dry eyes. I'm a commercial pilot and my dry eyes have begun to seriously affect the quality of my vision. I still have 20/20 in both eyes (with glasses that have a mild prescription) but reading letters & numbers on an eye chart is not the same as looking out the cockpit at night...

Like many here I've become very discouraged over the last 12-14 months (I'm worried for my career and constantly think about my vision deteriorating to the point that I have to quit, not exactly a stress-reliever) because it just keeps getting worse. I am currently on my 5th eye doctor. The first eye doc missed it completely, the second brushed it off and I spent a month doing things improperly, the third was very good but he has since referred me to two different specialists as, in his words, the problem exceeded his expertise.

The first specialist I saw did not seem to take the problem very seriously. I mean, I'm worried about my career in aviation being finished, and his only response is (after months and months of doing all these different things) 'just keep with it, in a few months it'll be better.'

I've only seen the second specialist once and will be returning in Nov. He seems to be much better and is taking my concerns a lot more seriously.

Here is my regime:
-Doxycycline 40mg daily
-6 fish oil pills/daily combined EPA/DHA ~2000mg
-hot compress (wash cloth) for 5mins followed by my attempt at lid massage, then lid scrub with ocusoft lid foam twice daily
-restasis drops twice daily
-soothe xp xtra protection eye drops as needed throughout the day
-sleep mask at night, minimal fan speed and a/c
-refresh PM gel drops in both eyes right before bed
-upper & lower tear duct plugs

I also try to wear sunglasses whenever I'm outside to protect the eyes, drive with the windows down as little as possible, a/c vents never pointed towards my eyes, and blink more often than I used to. One doc said I do not fully close my right eye lid.

I would also like to add that I am VERY good about sticking to my regime. For instance in the last 6 months I have skipped the lid compress twice. And believe me, when you have 8 hours total to check into a hotel, unpack your stuff, try and manage a decent sleep and then wake-up and eat breakfast, it is tempting to skip things, but I almost never do.

Basically the rub is, working in the aircraft cockpit is very dry, and I spend generally 70-80 hours a month in there (usually between 4-7 hours per day when I am flying). So I would guess the external factors are stacked against me in some ways. I usually show up to the doctor's office with a written list of questions but I was hoping to get some more info in the meantime.

One of my main questions is how the heck do you do a 'lid massage'? I read this: http://www.dryeyezone.com/encyclopedia/lidtherapy.html and specifically the section on lid massages, but I'm still not that sure what exactly to do. I've tried pinching the eye lid but I can't seem to really do it. I also never have seen the 'tooth paste' oil come out. Do you need a magnifying glass to see it? Or am I not doing it correctly? Also what is too much force, I'd really rather not damage my eye while I'm trying to help it! I have done a search and I didn't find what I was looking for, but if I missed a topic on this please feel free to direct me towards it.

Perhaps there is a good video out there that shows how the fingers should be placed, etc. ?

And finally, are there any other pilots on here, or maybe just people in extremely dry work environments with suggestions for combating the dryness?

Thanks.

[liz56]

Hi,

I'm sorry to hear about what you are going through. Many of us, through the worst of our problems, have been extremely concerned about our jobs and careers.

I wonder if you'd be a good candidate for moisture-chamber glasses that seal in the air around your eyes, which might be good during driving.

It seems that in your case you need to get your eyes to the optimal level of comfort for performance in the cockpit.

This might sound like a bizarre question, and it is one that might only come from the Dry Eye Zone, but, does your training include any discussion of blinking frequency and style? There are some threads here that stress not only blinking but pausing during blinks and not stressing the muscles when one blinks that have helped me. The one I recall is thinking of blinking like babies to, with relaxed muscles. I'll look for it. Even if it does not help during the flight, it may during your off hours.

Best,
Liz

[liz56]

Hi, again.

Here is the link to blinking advice:

http://www.dryeyezone.com/talk/showthread.php?t=8354

--Liz

[willwork4tears]

As a followup to Liz's excellent advise. I like to take long therapeutic blinks (mini eye breaks) where I close my eye and roll my eye around under my lid for a few secs. This redistributes the tear film and helps with the dryness. Hopefully you can sneak a few in while the copilot is in command.

If you sleep with your eyes partially open a mask may not be enough. I would try the Tranquileyes goggles or something that will weigh the lids down enough to keep them closed.

Ask your doctor about using Restasis more frequently (i.e. 3-4 times a day). Lots of us on here have either increased dose (concentration) or frequency. If you search for my name you can find some threads with good discussion about these options.

There are lots of threads on here about lid massage. I don't do it, so I can't be of much help other than to say most people report they cannot see anything coming out even with a high magnification mirror.

[spmcc]

I have to ask -- do you fly the red eye? (Agh! I know! harhar)

I agree with liz56... I think your best bet is to get your hands on some really good moisture chamber glasses (with or without Rx). The environment on planes is killer on the eyes. I've pretty much given up travel because of it (except to go see eye specialists ). I find that protecting my eyes from plain ol' air is the most helpful. Try explaining that to someone... air hurts me!!!

Do you know what your specific problem is i.e., aqueous deficiency and/or meibomian gland dysfunction?

Good luck.
Sheila

[dryeyepilot]

First of all, thanks everyone for the quick and informative responses, I'm glad for the support.

@liz56, thanks very much for the blinking advice, I'm going to read that article and hopefully it will help. I've looked at the moisture-chamber glasses before and I was sort of reluctant to get them for some reason, I think I might need to just get over it and order a pair.

As to blinking & training, I think you mean my pilot training. No, it doesn't include any mention of blinking. The doctor who pointed out to me that my right eye does not blink completely told me to consciously think about blinking fully whenever possible, which is the only guidance I've had on it. I am already trying to modify my blinking as I sit here typing this btw.

@willwork4tears, that is a great idea. I guess blinking plays a larger roll than I imagined before. There are plenty of opportunities in cruise flight to steal a few long blinks so it should be no problem. I just recently switched to a pair of goggles I got for free from a doctor (not fancy sealed ones, but still goggles) to test them out and see if I could sleep at night with those on. So far it's been mixed, but I think I might be able to at least sleep some nights with goggles on. My wife has told me that I sleep with my lids partially open.

I will ask my doc on my next visit about increasing restasis, although they did a test on tear production at my last visit and I'm making enough tears, they are just of sub-par quality in terms of the oils that keep them from quickly evaporating.

p.s. I like your name!

@spmcc, I do not fly the red eye but I do sometimes fly these things called 'naps' where you fly the last flight of the day, go to the hotel for a bit and then fly the first flight out in the morning...pretty hard on the eyes I'm guessing.

As to the specific problem, all the doctors agree that my problem is the quality of the tears I produce, that they do not contain enough oils, so they quickly evaporate (meibomian gland dysfunction I guess), but before the tear duct plugs & restasis I was also not producing enough tears (I'm guessing that is aqueous deficiency). Also belphartis, but for the last 6-8 months that has sort of been brought under control by the lid cleaning, etc. according to my doctors. So maybe I've done one thing right...

[Guest]

I just recently switched to a pair of goggles I got for free from a doctor (not fancy sealed ones, but still goggles) to test them out and see if I could sleep at night with those on. So far it's been mixed, but I think I might be able to at least sleep some nights with goggles on. My wife has told me that I sleep with my lids partially open.

Hopefully you can find a pair of goggles that is comfortable for you... a lot of people here find the Tranquileyes goggles to be very good (I've tried them out, and they are indeed quite comfortable once you get accustomed to sleeping with something on your face!)

The fact that your wife noticed you sleeping with your lids partially open might be a good thing in that at least now you know at least one reason WHY your eyes are so dry - at least now you can tackle the cause head on, and hopefully resolve your dry eye issues completely over time. And if the open lids at night thing is the ONLY cause of your dry eyes, then once you fix that, things should improve dramatically for you!

Keep us posted on how things go!

[mattias]

Dear dryeyepilot,

I'm sorry to hear about you dry eyes condition. I write you because I'm suffering from dry eyes as well and I'm working as a commercial pilot on A320 in Europe - and I've been trough a lot of stress and fear for having to give up my carreer as well. But I have very much got my condition under control by means of some simple routines.

First of all a bit about my own condition:

Since being a teenager I've had a tendency for dry eyes without ever giving me big trouble. After started flying commercially it was mostly all the early mornings and late shifts and change of patterns that was worsening my dry eyes. But after starting on jets five years ago it all really got worse - because of the very dry air, I suppose.

Without ever seeking any info on dry eyes I tried these OTC Get-the-red-out-drops for nearly a couple of months until I realised how much harm they did. And this is where it all started. Now the dry eyes really kicked in and I really felt bad about having "destroyed" my eyes and felt that it would never get back to normal again. I tried all kind of artificial tear drops without succes and the more time went by, them more anxious I was about solving it to save my carreer.

I was also hoping that the moisterchamber glasses would be really good for me when flying, but to be honest they didn't work for me.

It was not until I got a little progress by trying Dwelle eye drops that things started to get better. I also read about the lid scrubs (which I really didn't understand how to do either) and I always do these in the morning and in the evening. In the beginning I also used the foam as you, but now I found Blephagel (http://www.imedpharma.com/index.php/...iene/blephagel) which seems to be very soothing due to its cooling and very soft appearence.

Regarding the lid scrub: I always close my eyes and use my middlefinger to massage/wash the eyelids and the margins, just as if I was gently rubbing my eyes, paying particular attention to cleaning the eyelashes. But to use your finger (as opposed to a Qtip or cotton pad) you have to be very thorough about washing your hands before doing the procedure. Actually I always disinfect my hands with antibacterial gel and cleanse with water before the scrub.

Generally I'm always very careful not to touch my eyes without having clean hands since they seem very sensitive to small infections. So in a dirty flight deck I never touch my eyes...

Regarding flying and dry eyes: I always use eye drops (Dwelle) before and after a flight (I do shorthaul as you) and on longer sectors I drop en-route as well (it may sound stupid but I found out that having one bottle for using in the air and one for the ground is good, since the change in cabin pressure would make the eye drops foam and overflow if using the same). And always change bottle at least one time per month due to risk of contamination.

Another thing I did to reduce the level of stress was to do a Loss of License insurance with a big lump sum if things should get worse. That kind of gave me more peace of mind.

When things started to get better I also got back more energy for things outside work and I found out sports help a lot on my dry eyes as well. So I try to do sports at least every second day, which is one of these things that give back more energy than what you invest in it.

All of these things added together meant that I could finally get on with my life and feel that I had the confidence and the peace of mind to do the job which seems so easy on a daily basis, but which demands a clear mind when things get nasty in the air.

I know that you already get treatment and that you have sound daily eye routines, but I found out how important to believe in that things can and WILL get better if you want it to - and especially if you approach the problems with a smile. Without knowing your personal situation I think your level of stress could be a trigger for making your dry eyes worse, so it might be worth identifying your stress factors and try to eliminate them. This helped a lot in my situation.

I still get those bad dry eye days once in a while, but at least I don't let them decide if it will be a good or a bad day for me anymore...

I hope you can use some of my thoughts on it.

All the best, Mattias

[dryeyepilot]

Mattias, thanks for your detailed reply, it's given me at least a little bit of a moral boost. I'm glad to hear there is at least one commercial pilot out there who has overcome this problem. I'm definitely going to check out the Dwelle eye drops.

I try and make sure my hands are clean before the lid scrub, but it sounds like a being very careful won't hurt.

Flight deck, wow you aren't kidding, that is one dirty place! That and touching the outside of the airplane makes for some dirty hands. Until last year I never thought about insurance things, I thought, hmm that is only for older folks, but then I broke my wrist while cycling and was out of work for months. And I realized that even a young, healthy 24 year-old could be put out of work and need disability insurance. Here again, I never thought about loss-of-license until very recently, I guess I still have more of the 'young & invincible' mindset than I thought I did.

I have to say, the stress I feel is pretty serious. Hopefully loss-of-license can lessen it somewhat. I'm also looking into taking 1 month off from work to help my eyes 'catch-up' and not be constantly fighting against the harsh cockpit conditions.

After trying so many different things for my eyes and seeing so many doctors (and I realize how many doctors I've seen pales in comparison to what many on Dry Eye Talk have) say, "ok well the last thing didn't work, but this one will" and getting my hopes up, only to have them slowly dashed as it becomes apparent that things are still getting worse it's really hard to keep a positive attitude. I'm at least hopeful that taking a month off might help. Also my newest doctor seems to be very frank, he wasn't sugarcoating anything, which certainly keeps me from getting my hopes up.

[Guest]

Here is a link that I've found very helpful re: all things dry eye (Thanks to Indrep for this link... he's the one who I initially found out about it from!)

http://www.tearfilm.org/dewsreport/p...DEWS-noAds.pdf

It's reputable, and goes over everything you could ever need to know about dry eye. The chapter on dry eye treatments is particularly useful for ideas to bring up with your doctor. Also, the chapter on causes of dry eye will hopefully provide some clues that might help direct your approach to treatment.

[Rebecca Petris]

... it's really hard to keep a positive attitude. I'm at least hopeful that taking a month off might help.

This can be really good in some ways and yet not in other ways. Sometimes time off just means more time to obsess, read discouraging things on DryEyeTalk, and get more worried. Not trying to dissuade you from doing it, but just a word to the wise, you may want to have a plan in place for what you would do during the month.

[irish eyes]

I endorse everything Rebecca says.

We are all different but from my own experience, I find it's easy to obsess if I isolate myself too much.

During your time away from work, take plenty of rest but set yourself a few objectives too.

Keep in touch with people who are going to make you laugh.

I've just checked my work emails to find a message from a colleague; she described something ludricous that a student had put in an essay. I can't get on with anything here at home because I keep giggling about it. It's given me a real boost.

[andreapandrea3]

Just wanted to add my two cents too:
Yes, yes, yes--try Dwelle! It's wonderful. It is my lifesaver at night.

Try the Oasis Tears Plus. They are an excellent drop for during the day.

Get one of Rebecca's rice baggies (or make your own)! Warm compresses for 10 minutes. When I first was suffering, I realized that I wasn't doing warm compresses for long enough to get the sludgy oils flowing. Now that my eyes are more under control, I have decreased to 5 min in the morning (my morning routine is crazy anyway), but I maintain that 10 min at night.

Also, I find that a hot shower helps loosen up my glands--so I start my warm compresses routine after that.

And lastly, I massage my eyelids with a warm clean washcloth afterwards. I put one finger in the washcloth and sweep that finger down my lid to my lashes (and up to my lashes when I'm doing my bottom lid). I can usually hear the oils squishing (haha, that sounds gross, but it's true!)

Good luck to you in improving. Remember to have hope--it will get better! I went through six doctors before I found one who was both helpful and understanding. Most mis-diagnosed me or tried to force me into things I wasn't comfortable with. The biggest thing for me was to figure out what works and stick to it.

[hopingforacure]

Don't give up

I sent you a private message.

[dryeyepilot]

Thanks for the replies everyone. Sorry it's been a few days but I've been on a trip and just returned today.

@SAAG, it's saved to my desktop, I just need to read it now! Thanks.

@Rebecca Petris, I think the trade-off will be worth it, and I'm already obsessing over it in my head all the time and I'm working tons lately, so I probably can't fit much more obsessing in anyways. I'm sure I can find lots of stuff to keep me occupied.

@irish eyes, visiting the gym 5 days a week is a current goal which I sometimes meet, but more often do not, so that's at least one objective...

@andreapandrea3, as I sit here at the computer I've got three different kinds of eye drops on my desk, but another kind probably wouldn't hurt! Tonight I will try 10 mins of hot compress and see how it goes. I'm trying my best to stay positive, thanks for the encouragement.