Second recurrence of dry eye, causing blurred vision

[SD3]

Hi,

Last week, after returning from a business trip in Las Vegas (yes, actually business), having spent the much of the time exposed to smokey, recycled air, I returned home with severely dry eyes. Despite using Systane drops for a few days, conditions worsened to the point where it felt like there was a little bit of sand paper under my eyelids every time I blinked (grittiness/foreign objects sensation I guess).

A visit to the OD confirmed that my eyes were in fact very dry and that the outer tear layer was not in good shape -- my eyes are producing a low quantity and low quality of tears.

(Quick background -- I had the same issue October 2010, except the grittiness was less intense initially. Using Restasis for about 2-3 months put me back to normal.)


Anyhow, here is my treatment regimen:

-Artificial tears (Systane), 1 drop per eye, every 20-30 minutes, for the last week.

-Hypertonic ointment to draw fluid out of the eye and reduce inflammation/grittiness/foreign object sensation. 2x daily, for the last week. Discontinued yesterday because it wasn't doing the trick and was just gunking up my eyelids.

-FML corticosteroid, because the aforementioned ointment didn't work. 4x daily, each eye, starting yesterday. This has diminished grittiness sensation significantly.

-Back on Restasis, 2x daily, as of yesterday.

-Nature Made Super Strength Omega-3 (1000mg EPA, 200mg DHA). 2x daily, starting 3 days ago.


Environmental/other considerations:

-I am moving out of my carpeted apartment over the next two weeks into a new place with hardwood floors. I moved into this place (carpeted one) two months before my 1st encounter with dry eye (obviously I'm really hoping the carpet was the cause).

-I spend 6-8 hours a day in front of a computer doing graphics work, and just started using the blinker thing on this site (thanks).

-I am nearsighted (-3.25 L, -2.5 R). Discontinued contact lens usage about 10 days ago.


So, my big questions, which were my reason for joining the board:

I have had blurred vision in my right eye for about 5 or 6 days running. Is this simply due to dry eye (as I have read about)? Should I be worried about corneal abrasion/damage? If not, how long should I expect blurriness to last? I am concerned because I didn't have this issue the last time I had dry eye in October 2010.

Thanks in advance for your help.

[PotatoCakes]

Did your OD mention corneal damage? It couldn't hurt to call and ask if he/she didn't mention it. You may not have corneal damage but it's certainly something to consider when approaching care. If you don't feel confident in your OD, look for a corneal specialist in your area and go from there.

Dry eye caused some damage for me. I don't know how bad it was but it appears that the serum drops I've been on have repaired the damage (I still use serum drops regularly and may have to forever, assuming there isn't some new advance or my body doesn't start producing tears but at least I worry less about damage).

[littlemermaid]

Orthoptist taught us this: Is it eye damage or normal short-sightedness change (myopic)? Look at a blurry image or writing across the room. Make a small hole in white card and look through. If you can see more clearly it is correctable myopia. We did also have temporary change because of inflammation.

[SD3]

Thanks for the replies.

PotatoCakes- My doctor mentioned that if my dry eye got severe, there could be damage, but didn't mention specifically if mine was at that stage yet. I think the blurriness has gotten a little better since I saw him on last Monday. When I put my normally -2.50 right eye behind the -3.25 left lens of my glasses, things appear about normal.

littlemermaid- thanks for the tip. It is kind of hard to test that with glasses on because light still gets in around the lens. However, when I squint my right eye (with glasses), I think my vision gets ever so slightly clearer.

If there is a possibility that there has been damage, does that need to be addressed immediately? Or would I just need to go on treating my dry eye as I am? Although I have health insurance, I am young and don't want to spend the money to have a doctor say something to the effect of: "you have a little damage but you should just continue what you've already been doing." My last visit to a specialist after my first case of dry eye 8 months ago (my OD recommended I get a second opinion) ended up costing me $300 (out of network), and she only confirmed what my OD and I already knew.

[nycdryeyegirl]

Hi!

I would suggest contacting your eye doctor, if you are experiencing blurry vision, since this symptom could be related to many eye disorders and only an opthamalogist would have the professional experience necessary to correctly evaluate you.

By the way, you might wish to consult with an corneal specialist and/or ocular immunologist(doctor who specializes in inflammatory eye disorders) for your dry eye condition.

I hope this info is helpful for you.

Pam

[SD3]

Thanks for the advise. I will be seeing an ophthalmologist (who specializes in dry eye, among other things) within the next week or two in order to find out what's going on.

[PotatoCakes]

Glad to hear you're going to see an opthalmologist. If you've had issues in the past, I wouldn't chance it by not seeing a specialist now.
One tip... when you put your drops in, keep your eyes closed for 2 minutes, if at all possible. One of my specialists told me this (finally -- he just assumed I knew) and while it doesn't always make a difference in how long the drops last, it definitely makes a difference some of the time.
Also, the Systane you are using, is it preservative free (in small single-use vials)? If not, time to switch. Single use vials are more expensive but a lot of us use them because the preservatives in bottled eye drops can cause more dryness.

[SD3]

OK so finally saw the ophthalmologist on Friday. Here is the treatment regimen he prescribed:

1) He said I have moderate blepharitis, so oil is hardening on the edge of my lids, blocking the meibomian glands. He recommended I use hot compresses 1-2 times/day to help loosen the oils.

Question regarding hot compresses: how long do you apply them for? I am fine with the maximum temperature that my faucet reaches, so what I did once or twice per day this weekend was stand over the sink, alternating between saturating the washcloth with hot water and holding it against my eyes. This cycles lasts about 20 seconds or so, and then I repeat until it's been 3-5 minutes. Is this enough?

2) Like you said, he told me to switch to preservative free vials. So I've been using Refresh Plus. I dunno if it's just the lack of preservatives, or also the different active ingredient than Systane, but the Refresh+ vials feel much better. With the bottled Systane, my eyes would get gooey, then feel fine for ~2 minutes, and then feel dry again.

3) Azasite before bed (but after Restasis). My eyes tear up after applying, but other than that no big deal. I don't feel the stinging sensation as badly as others have been talking about. He said if things don't clear up within a month, he'd switch me from Azasite to some oral medication (I forget what).

4) Abandon the lid scrub.

Compared to last week, in which I was working at a computer during the day, and moving out of/cleaning my old apartment way late into the night (and not getting much sleep, every single night), the three days of this treatment feels like it's going in the right direction, though it's tough to tell. I'm hoping the fact that my new place has hardwood floors (vs old carpeted apartment) helps. Anyhow I may post on threads for each of these particular items, esp. Azasite, once I've been doing this for longer.

Thanks for the help.

[Hopeful2]

Sorry to hear what you are going through. I can't address all your points, however, I can comment on the warm compresses and the computer work.

Warm compresses are very commonly prescribed for dry eyes, particularly dry eye due to blepharitis and meibomian gland issues. I think many people here on DEZ use a dry approach to the warm compresses. They use a rice baggies that is made from clean sock and dry white rice. You can put about 5 tablesoons of rice in the scok and close it off by tying a knot. Micorwave the sock for about 20 sec. It should feel warm to the touch. If it feels hot in your hands, it will definetely be too hot for your eyes. You can rest on the couch with the compress for about 5 min. Some might prefer a little longer, but 5min is a good amount of time. Many of us prefer to place a thin wet cloth between our eyes and the rice bag. You will still get the heat, but it won't have the drying affect that you can sometimes get with just the rice baggie. By the way, save you rice bag because it is resuable!

For computer use, you might want to use moisture goggles to help keep eyes moist. You might want to instill drops before you use the computer. Also plan on taking regular breaks from the computer in addition to having a 'blink' icon on the screeen.

You might want to check out the DEZ store, just to see waht some people are using. Also, Rebecca's 'Dry eyes for dummies" is a very good resource.

Sounds like you are on the right track.