morning normality, afternoon deterioration

[czee]

hello friends, this is my first post.

i'd like to start off by thanking the person who started this site and the contributors who share information here, you are doing so much good for a lot of people.

dry eye is proving to be the biggest stumbling block of my young life thus far.
i'm an otherwise very healthy active individual who first started noticing mild symptoms about 18 months ago. since then i have been to three opthamologists. the first said i had blepharitis, gave me something called 'tobrex' which i stopped taking after a few weeks because my eyes felt terrible in the mornings and there was no improvement. the second doc performed a battery of tests, none of which were explained fully, he did however say it was a 'issue of quality not quantity', whatever that means. the third had an office lined with medical diplomas and lifetime achievement awards yet he didn't provide a proper diagnosis or add any value whatsoever.

based on what i have read here on this forum i have mild symptoms. i don't have pain, the wind doesn't really affect my eyes, my vision is just fine, and the burning i sometimes experience is almost negligible. the problem is that my mild symptoms are preventing any doctors from taking me seriously!!! they all suggest the same 'management' treatments without really tackling the root cause.

i have a theory though that i think is plausible. regrettably, when i was 16 i took accutane. it was extremely effective, BUT even after stopping treatment my skin and scalp were a little dry, not extreme dryness, just dry enough to warrant usage of moisturizers. over the last 18 months (the same timeframe as my dry eye problem) my scalp and skin has become much drier.

dry scalp/dandruff=blepharitis=possibly mgd

so it follows logically that clearing up the dandruff, and then the blepharitis could solve my problem, is this just wishful thinking on my part or is there anyone else who has gone through these steps and had success?

also, my eyes are normal in the morning, to the point where drops (systane) just aren't necessary, should i be putting them in anyway?

any input would be immensely appreciated. thank you.

[aga]

hello friends, this is my first post.

i'd like to start off by thanking the person who started this site and the contributors who share information here, you are doing so much good for a lot of people.

dry eye is proving to be the biggest stumbling block of my young life thus far.
i'm an otherwise very healthy active individual who first started noticing mild symptoms about 18 months ago. since then i have been to three opthamologists. the first said i had blepharitis, gave me something called 'tobrex' which i stopped taking after a few weeks because my eyes felt terrible in the mornings and there was no improvement. the second doc performed a battery of tests, none of which were explained fully, he did however say it was a 'issue of quality not quantity', whatever that means. the third had an office lined with medical diplomas and lifetime achievement awards yet he didn't provide a proper diagnosis or add any value whatsoever.

based on what i have read here on this forum i have mild symptoms. i don't have pain, the wind doesn't really affect my eyes, my vision is just fine, and the burning i sometimes experience is almost negligible. the problem is that my mild symptoms are preventing any doctors from taking me seriously!!! they all suggest the same 'management' treatments without really tackling the root cause.

i have a theory though that i think is plausible. regrettably, when i was 16 i took accutane. it was extremely effective, BUT even after stopping treatment my skin and scalp were a little dry, not extreme dryness, just dry enough to warrant usage of moisturizers. over the last 18 months (the same timeframe as my dry eye problem) my scalp and skin has become much drier.

dry scalp/dandruff=blepharitis=possibly mgd

so it follows logically that clearing up the dandruff, and then the blepharitis could solve my problem, is this just wishful thinking on my part or is there anyone else who has gone through these steps and had success?

also, my eyes are normal in the morning, to the point where drops (systane) just aren't necessary, should i be putting them in anyway?

any input would be immensely appreciated. thank you.

Do not use drops if you do not need them. They are addictive-as more you take them as more you need them. Yoyr doc should have told you that!!!!! My eyes are much better when I decided to...stop using night gels.

[Rebecca Petris]

Dear czee,

Welcome! I'm glad you found the forum.

the first said i had blepharitis, gave me something called 'tobrex' which i stopped taking after a few weeks because my eyes felt terrible in the mornings and there was no improvement. the second doc performed a battery of tests, none of which were explained fully, he did however say it was a 'issue of quality not quantity', whatever that means. the third...didn't provide a proper diagnosis or add any value whatsoever.

I know they may have seemed unhelpful but there may be more to what you were told than you think. The first two are probably right (meibomian gland dysfunction / some kind of blepharitis) - tear quality is referring to the composition of your tears, which poor meibomian gland function or other conditions can affect, as opposed to not producing enough watery tears from the lacrimal glands. It's entirely possible the third did diagnose you but is a really bad communicator. I say this because sometimes people get big surprises if they ever get a written copy of their records from a doctor who never said much.

they all suggest the same 'management' treatments without really tackling the root cause.

Well sometimes it can be pinned down and sometimes it can't but often the treatments will be the same or overlap. By the way was it the Tobradex making you feel worse in the mornings or just symptoms getting worse?

It's kind of hard to draw a clean line between "management" treatments and other treatments with this kind of condition. The same things that may just help some people survive day to day may be more therapeutic for others, getting them to a point where they need less and less.

i have a theory though that i think is plausible. regrettably, when i was 16 i took accutane.

Several members blame their dry eye on accutane and there's a known connection. It hasn't really been studied. Just based on anecdotal reports though I don't think it's something that reverses itself very quickly.

also, my eyes are normal in the morning, to the point where drops (systane) just aren't necessary, should i be putting them in anyway?

If you don't have moderate to severe dry eye and/or haven't been advised to use them regularly I wouldn't bother - I'd use them as needed. But I don't agree with the member who says they are addictive. Some people become 'addicted' to drops in the sense of using them much too frequently to kill symptoms rather than pursuing other tools/approaches, but I don't know that there's any evidence you "need" more if you use them, unless you're using ones with damaging preservatives or that are harmful in some other specific way.

[czee]

thank you for your input.

yes, the issue with the doctors is partially my fault because i didn't press them for more answers and explanations. dry eye just seems different to other types of ailments where you are usually passive in the process, with dry eye you need to be proactive and informed. at that time i was not informed because i believed the doctors would sort the problem out. im currently waiting for my copy of dr lats book so i can get myself up to speed.

theres no question that accutane played a part, through two possible mechanisms 1) decreased oil production, which led to 2)dandruff/dry scalp = bleph=mgd.

thankfully i was not on accutane for a full cycle, only about 3 months, so i think i got through relatively unscathed. through dietary changes and generous omega 3 supplementation i've been able to increase oil production significantly, to the point where it may be normal again, or very close. im getting the odd little pimple here and there, never thought i'd be happy with that sort of development!!! i was really worried that accutane completely fried my oil producing glands, but i think the main effect in terms of dry eye has been the dandruff-bleph link.

what an awful thing it is though, i regret massively ever having gone on that poison. just this week i read an article in the paper about studies linking it to teen suicide.

wrt to the tobrex/tobradex, it made my eyes really dry, red and scratchy in the mornings and the symptoms the rest of the time were unchanged.

the question i have is: will warm compresses and lid hygiene actually clear up the bleph? (assuming that it was caused by dandruff and that is cleared up) or is it just going to make dry eye symptoms more tolerable?

if not, should i be heading back to the opthamologist or is there some home remedy apart from the above mentioned routine that will clear it up?