Hello - 48, male, New Grad RN Here Almost Debilitated with Harsh MGD Onset

[TimB]

Hello,
Newbie here, 48 years old male. 9 year old Lasik, never had dry eye problems with. However, 16 month old PRK enhancement in right eye seems to be coinciding with a worsening and now debilitating dry eye problem over the last year. It's almost a miracle I made it through nursing school!

Help. Does my doc know what he is talking about?

1) he is telling me that my meiobian glands are producing too much oil not too little.
Schirmer Test (that I requested today): 15 right eye, 24 left eye
Did not perform TBUT (?)(!)

2) he says that Azasite is known to thin out the excessively thick oil layers. ?

3) he is also offering IPL as one option ($200 for a single treatment on both eyes...says some patients are reporting 6 months to a year of relief)

4) he didn't seem too convinced or impressed with my wanting to get to the real root of the problem (i.e., possibly allergies or "condition X" in tandem with PRK...) and made it seem like MGD was just something that had to be dealt with chronically now. Hrumph.

So basically, he is talking about Azasite and IPL, Doxy and of course steroids as needed but very discriminately. He's not a bad doc but I just feel like he's not getting my angle regarding wanting to find the real cause. Plus I thought MGD was too little oil not too much? He also recommended another Doctor that specializes in MGD when I kept driving home the point that my functioning is to the point of debilitating in frequent exacerbations.

I wake up very swollen every day and take a 20 minute hot shower to ease it down.

My eyes have been sensitive my whole life. Extreme seasonal allergies/hayfever which has subsided in the last 10 years (I'm 48).

I sleep with a cat. Who knows, right? Can anybody relate on allergies as a possible solution?

I'm a scientifically minded new grad RN and having a hard time connecting the dots here with what I'm learning day by day. I just ordered the 2 books recommended on this blog but don't have them yet.

I'm very depressed because my exacerbations are extreme and interfering with my getting my first RN job.

I'm rambling now. I hope to establish some productive relationships here. My goal is to find what works for me (past just symptom management) and then share my success with others.

I'm doing warm compresses,Genteal ointment at night,100mg oral doxy BID (ending soon), just completed 6 weeks Maxitrol (IO pressure 14 so I'm cool). I have 2 free samples of a steroid like Maxitrol for judicious use when I need it.

Help.
Tim

[Rebecca Petris]

Welcome. Sorry you have reason to be here?

I wake up very swollen every day and take a 20 minute hot shower to ease it down.

I'd sure suspect allergy.
Ever tried cold rather than heat to reduce the inflammation?

I sleep with a cat. Who knows, right? Can anybody relate on allergies as a possible solution?

Check out Scout's posts, including the one in this thread.

[TimB]

Thank you Rebecca, I will take your advice and check out that thread. Thanks for the site. I spent hours yesterday reading one of the Docs Q and A blogs. The information here is invaluable. I hope to come out of this with some answers to share.

[tearless2]

Hi Tim,

I have aqueous deficient dry eye but back when I first got this problem, I also had some accompanying blepharitis. I took azasite and although it burned a bit the first time I put it in, it gradually got less and less painful after a few days and REALLY helped clear up my blepharitis. Of all the things your Dr. has mentioned, it looks like the least invasive and least expensive treatment options. I believe it has fewer side effects than steroids.

Have you been tested for allergies?

Does the warm compress help? How about cold?

[TimB]

Hi Tim,

Have you been tested for allergies?

Does the warm compress help? How about cold?

Hi, thanks for the suggestion. Since seeing the doc on tuesday I've decided to approach this from an allergy perspective as an experiment.

From looking at this website there seems to be a dichotomy. There is one camp of people spending a great amount of effort exploring symptom relief with varied results. Then there is another camp, much smaller that considers allergies.

Before I resign myself to a lifetime of symptom management I want to attack the allergy possibility full force. Warm/hot compresses for example. Think about it. If it is allergies driving my condition then the use of warm compresses is aggravating the situation. So I stopped and switched to cool compresses yesterday.

Most amazing so far, yesterday at 3pm I took a Claritan antihistamine. Within 30 minutes my eyes felt.....normal. They still look bad but wow. I went to Trader Joe's to grab some things when I realized how awesome my eyes felt. Or perhaps saying it this way is more accurate. I realized they my eyes felt like nothing was wrong with them!

Not to get too excited, I am now contnuiing my allergy approach cautiosly optimistic. Someone on this site posted a manifesto on approaching MGD from an allergy perpective. I printed it out and am going to implement more controls in my home. I've also dimmed the display on all my computer monitors. There are so many things you can do. Perhaps most important however is to take a break from the steroids and doxy and hot compresses.

No, I haven't been formally tested for allergies. I will do that. As a younger man however, my hayfever was so severe (eyes mainly affected) that I needed an annual steroid injection (kennolog) throughout my 20's.

So although I have a huge risk factor (PRK), I think it's too simplistic to resign myself to the chronic sentence of MGD. Rather I am hopefully with Dr. Latkany's approach that it is not the PRK that is the root causation but PRK and X. If I can figure out what X is, I think there is some hope.

Thank you for your interest. Right now I'm trying to avoid the first line treatments like Azasite but of course it remains an option.

Tim

[Sammy B.]

Dear Tim,

I also used to sleep with a cat in the bed and since we've moved her out of the room and started shutting the door at night (cats can be very persistent!) my symptoms have really improved.

I have been tested for allergies and am allergic to the majority of things they test you for.

So yes, allergies can play a big role in eye discomfort. Also, it could be a mix of a few small things that are causing the issues and not just 1 major thing, so explore all avenues that make sense to you.

Rose

[TimB]

Rose, thanks. I'm still doing really well which is amazing considering I'm off the steroid and doxy. It's hard to think about kicking my cat out of the bed. I think I'll try to sleep on the couch a few times but since I'm doing ok I'm really going at the dust mites right now and it at least seems to be working! Tim