Dry eyes - where do I go from here?

[littlemermaid]

AprilShowers,
Restasis: I've signed up for Moorfields catalogue access pretending to be a pharmacist (heh heh) but according to UK drug regulations we only have NHS Optimmune, the vet stuff (it's 0.2% cyclosporine + petrolatum base), which we got from them no probs and any doc can get this now. I had a tip-off that some dodgy chemists would order Restasis from overseas if they had it in their supplier catalogues... but they had second thoughts, just as well. I could fancy a trip to the States myself.

Good tip about the saline 0.9% Minims, they work great for us all through the day, without chemicals.

Jasmine,
Do you mean Theratears nutrition or eyedrops?

You can definitely get second opinion and follow-up NHS, and quickly in private practice - we've found it reassuring to talk to different experts and ask questions, particularly to see what else can be done. What do you think about the LASIK provider - do you think there's a chance they may come up with new treatments before other docs? Are you seeing someone consultant level?

[Jasmine]

Dry eyes - where do I go from here?

Aprilshowers - I've actually ordered both but they haven't arrived yet, I think they are coming from the USA and I can't wait to give them a try.

Can I just ask the people who are using Restasis, can my Lasik provider prescribe and if so what if he refuses - can my GP then prescribe or do I need to see an Eye Consultant first? Also is it for long-term use or is it just a short course? Sorry its just that i don't really know anything about it.

You are right Sunshineincalgary my eyes are probably a lot better than most.

But as I tried the plugs some time ago and I am now a lady of a 'certain age', I have found that they are definately more sore and painful over the last year or so. Sometimes I get an ache around my eye socket and I am unable to squeeze a tear out, I'm sure this is also related to my dry eyes.

Thanks for all your helpful comments

Jasmine

[littlemermaid]

Boots, Lloyds etc will be delighted to sell you any prescription eyedrops they can find in online supplier catalogues - speak to a qualified pharmacist, they will get anything that's UK approved or NHS with any doc's prescription. Restasis is not UK approved yet so we have to use Optimmune, which is now available NHS. Preservative-free saline Minims is easily available.

http://www.cks.nhs.uk/dry_eye_syndro...y_eye_syndrome See eyedrops.

You can check what's available NHS specifically in your region (GP, pharmacist, hospital pharmacist, or search in PCT website). It might save you a lot of money in the long run to get NHS monthly prescription for tear substitute eyedrops - we get preservative-free normal saline 0.9% and Hyloforte (check which preservative-free hyaluronic acid drops are funded NHS in your PCT). Prescription would be from NHS eye docs or your GP. The normal process is - NHS eye clinic assesses, prescribes for hospital pharmacy eyedrops, writes to GP, GP budget pays for ongoing prescription.

Jasmine, You need an ophthalmologist who is careful and skilled at healing the eye surface - I wouldn't use cyclosporine without good advice and monitoring. From this point of view, your post-LASIK guy sounds sensible, but an NHS specialist consultant (anterior segment, ocular surface disease) second opinion either NHS or Private has to be a good idea since things aren't improving as much as he hoped. If you are also with an NHS eye clinic, you get access 24/7, with medical records, and NHS prescription eyedrops.

Important to keep with the LASIK clinic for free treatment unless you suspect they're incompetent - are they paying for all this? They're not charging you, are they? Is he qualified as an optometrist or an ophthalmologist? Is he qualified to prescribe? The secretary or desk staff will tell you discretely if you 'phone up.

[Jenn1]

AprilShowers,
Restasis: I've signed up for Moorfields catalogue access pretending to be a pharmacist (heh heh) but according to UK drug regulations we only have NHS Optimmune, the vet stuff (it's 0.2% cyclosporine + petrolatum base), which we got from them no probs and any doc can get this now. I had a tip-off that some dodgy chemists would order Restasis from overseas if they had it in their supplier catalogues... but they had second thoughts, just as well. I could fancy a trip to the States myself.

Good tip about the saline 0.9% Minims, they work great for us all through the day, without chemicals.

Jasmine,
Do you mean Theratears nutrition or eyedrops?

You can definitely get second opinion and follow-up NHS, and quickly in private practice - we've found it reassuring to talk to different experts and ask questions, particularly to see what else can be done. What do you think about the LASIK provider - do you think there's a chance they may come up with new treatments before other docs? Are you seeing someone consultant level?

Are the saline minims on prescription and would the Optimmune benefit bleph and mgd, and if so how? And dont you find the saline too thin to be an effective lubricant for the eyes?

[littlemermaid]

Yes, normal saline 0.9% Minims are available on prescription off the NHS lists. It's not really a lubricant for us, it's a tear substitute in frequent use that causes as little damage as possible while the tear film is not bad and we're trying to heal the surface and get everything functioning again. So, yep, it might be too thin depending what's needed.

Optimmune is cyclosporine, an immunomodulator that controls inflammation, same as Restasis. NB it has a paraffinum base so it depends how that's tolerated as well. Jury's out on who it works for, as far as I've read. Maybe it depends whether a cause of the blepharitis, mgd, lacrimal deficiencies is inflammation; search here for people's experience, PubMed, Medscape, US FDA (there's at least 2 spellings - cyclosporine, ciclosporin). Maybe with rosacea we need to make good meibom, keep the mgs moving, and keep skin inflammation down -mgd isn't the whole story because there are other glands and processes making tears which are impaired by inflammation.

***
Jasmine ~ I was just thinking that where you are right now, if you haven't got Dr Robert Latkany's book 'The Dry Eye Remedy' I'd be ordering it off Amazon because it helps LM and me a lot. I go back to it often because it's confident and reassuring and gives useful advice. Also helps as a basis for talking to docs and I keep it in my bag for confidence.