Dry Eye Post Lasik- Running out of Options

[c3neely]

My names Chris, I've been lurking for awhile. I had Lasik in January 2010...its been a wild ride since. A lot of people talk about having problems after the surgery..but gradually getting better. I feel like mines been the opposite, as they feel worse today then I remember them feeling in the beginning (obviously they hurt initially for a few weeks pretty bad, but seemed to get increasingly better up to a point).

Im convinced now that I wasnt a good candidate...i did struggle constantly with wearing contacts, but was never officially diagnosed with dry eye. Honestly, I always thought it "was" the contacts, and if I could get rid of them, i'd be good to go and could put in drops if I had problems with dryness. They did the Schirmers test, and I passed it...so i didn't think too much of it....I realize now that I really shouldve been made a bigger deal about my dryness issues, but I didnt realize it at the time, and they played it off when I did talk about it. It just sounded "too good" to not do...hearing people who got it done who didnt have to fumble with glasses or contacts. Today, I keep bouncing around to different doctors (which is such a Hassle..when u get to a new doctor, and the guy starts talking, and within a few senetences u already KNOW that the guy cant help you)...getting new prescriptions...and Im to the point now where its basically "im not going to cure this...but, hopefully I can manage it better."

Do you guys suffer from Allergies as well? How big does that play a factor into your eyes? I know that I have allergies, which are part of my itchiness and discomfort...but, when I try to do something about that, I feel like my eyes get worse (side effects of Antihistamines can be dryness)...im really curious to when winter comes around what effect thats going to have on my eyes, bc honestly I don't remember last year if they got better or not (I had a major knee surgery on my knee last year, and that was my main focus, not my eyes).

These are the things that I've tried/currently use:

I have both ducts plugged up
I take 6 fish oil capsules a day (3 months)
Restasis twice a day
Eye Lid cleaning in the shower
I try to do hot compresses, which I can tell help a little bit with the oil, but, that does me no good when Im out for the day
I just ordered Lacrisert...I tried a sample yesterday at the doctor...its not a cure, but I felt like it helped enough to give it a try
I bought a humidifier today (thinking about getting like 3 of them..keeping one in the car/bedroom, and near computer)
I tried Azasite, to help with blepharitis (which i never got diagnosed with, but we tried it anyway...my eye lids hurt like hell, so im sure its a factor)
Just recently ordered these: http://www.eyeeco.com/product/iprodu...e_eyewear.html
Moisture Release Eye Wear from Tranquileyes..im actually really excited about them, but trying not to get my hopes up. Ill report back if they help, should be here tomorrow

And i looked into Lipiflow...but i just KNOW itll probably help a little bit...but not enough to cost $1500, or not last long enough to cost that much


anyway...just venting. Comment if u can relate

[bakunin]

Hi c3neely,

An article that maybe explain why you feel worse almost 2 years after LasiK

http://www.ncbi.nlm.nih.gov/pubmed/1...?dopt=Abstract

CONCLUSIONS:

Both subbasal and stromal corneal nerves in LASIK flaps recover slowly and do not return to preoperative densities by 3 years after LASIK. The numbers of subbasal nerves appear to decrease between 2 and 3 years after LASIK. The orientation of the regenerated subbasal nerves remains predominantly vertical.

[c3neely]

Based off of that link/conclusion...does that mean this is how they are just going to be...or that they are still healing based off that study?

[bakunin]

Based off of that link/conclusion...does that mean this is how they are just going to be...or that they are still healing based off that study?

I think the research conclusion is that subbasal nevers increase til 2 years after Lasik, then they deacrease again between the second and the third year. But as the research stops on the third year we don't know if the nerves increase again after the third year (I think so and hope so).

So maybe you are entering the period when your nerves are decreasing in density (something around 2 years after Lasik). If we can trust that research, of course.

What I would say to you is that if your getting worse it doesn't mean you won't get better again. Maybe it is just a period when you nerves are descreasing.

[Sammy B.]

Hi Chris,

I'm post-LASIK too and get along very well these days. I had LASIK in, geez, I don't even remember now, I think 2008. I too struggled with contacts and should have been more wary but went into the LASIK thinking I would be one of the fortunate ones. Heck, I guess I can consider myself fortunate because I can freaking see....

Anyway, my suggestion would be to get a real diagnosis as there are two basic types of dry eye: aqueous-deficient, which means you don't make enough water in your tears, and lipid-deficient, which means you don't make enough oil. You can have a mix of both. The general thinking now is that most people who have dry eye problems have lipid-deficient dry eye aka MGD (meibomian gland dysfunction) aka posterior blepharitis. So once you get your diagnosis if you hear any one of those 3 terms mentioned you'll know that you have a lipid-deficiency. Doctors might also say that your "glands are blocked," this is another key to MGD.

So, find a good doctor who can tell you what your exact diagnosis is - do you have little to no water in your tears (they can tell this by doing a Schirmers test) or do you have little to no lipids in your tears (they can tell this by doing a tear film break up or "TBUT" test)? If they tell you that you're water deficient, stick with the punctal plugs. If they tell you that you are lipid-deficient or have MGD, try to get rid of the plugs ASAP. From what I understand (and went thru myself), for people with MGD the plugs can cause more buildup of bacteria and worsening symptoms.

Lacrisert, Azasite and Restasis did not work for me but what works for one person won't work for another.

Here is what has helped me, I am an MGD sufferer (my water production is generally OK):

Doxycycline although I had to stop this because I am expecting
Sooth ointment at night (small amount, about the size of piece of rice, 1 in each eye)
Light eye mask at night
Much yawning/blinking in the AM to get the tears flowing before I try to stagger out of bed
Moisture chambers in the early AM before anyone gets up so I don't have to be embarrassed!!
Immediate eye rinse in the AM with non-preserved saline
Cleaning of lid margins in the AM with non-preserved saline on q-tips (top and bottom lids)
Small bit of Genteal Gel in each eye before entering the office
I'm fine all day and when I get home, after removing the makeup, I do the saline rinse and lid margin cleaning once again
SLEEP!
STRESS REDUCTION!

I should also mention that I did Lipiflow a few months back and that, so far, has brought me the greatest amount of relief (procedure-wise). I had also done the compresses and IPL, etc., to no avail. The key to MGD is keeping the glands open and flowing and keeping the bacteria at bay. You can do this by making sure you do some simple things like washing your face and eye areas thoroughly at night and even the saline rinses work wonders.

I do suffer from allergies as well and stupidly have 3 cats. Once they are gone I will be going pet free to see if that furthers my success.

Let me know if you have any further Q's.

Rose

[patrick]

Hi rose,

Long time since i saw a post of you here on the boards.
Great to see you are doing very well!
Hope your pregnancy goes okay as well. How long do you still have to go?
What i'd like to know from you is when you started to notice any improvement in your symptoms after you started taking doxy?
I finally managed to get the doxy prescribed by my general practitioner and i have been using it for a week now.I take 50 miligrams twice a day. Initially i will use this dosage for 6 weeks. My optometrist wants to check my eyelids after two weeks of use to see if things show any improvement at the slitlamp.

Patrick...

[Sammy B.]

Hi Patrick,

Thank you for the kind words! I am due on January 26 with a little boy. We are very excited!

I noticed an improvement in my symptoms after about a month and a half on the doxy. Basically I realized that the burning upon waking was gone and then throughout the day my eyes just felt way "tougher." I took a larger dose than you I think, 100 mgs twice a day. I did not have any stomach or gastro issues from the doxy as others have stated. If the 50 mgs doesn't work, I might ask the doc if they can bump it up. After maybe a year of taking the doxy, I realized that it is probably not good to use this long term. For instance I developed an ear infection while using doxy and I had to get on another antibiotic to clear it up. I'm not saying that the doxy caused the ear infection, I just think that continued antibiotic usage might lead to a weakened immune system.

Stopping the doxy is why I turned to Lipiflow. It seemed to be a more holistic way of dealing with the situation. I would still go back to doxy though if the symptoms started up and I didn't have the money for Lipiflow (and I wasn't pregnant!).

Good luck on it, it really did work for me.

Rose

[patrick]

hi rose,

thanks for your response.
i am only in my first week,so i have to be patient with it and wait for the improvement to happen i guess.
luckily i do not experience any side effects of the doxy either. so that is a good thing.
there seems to be a lot of discussion about taking anti biotics long term,especially here in europe.
to my knowledge it should be possible,safe and effective to use it long term in low doses (like 20 mgs per day) because it is not used it for its anti bacterial properties,but more for the anti inflammatory effect this drug is believed to have. however,nobody seems to be 100% sure about all this. opinions vary a lot to.
so,you are due in a little less than 3 months! that is indeed exciting. i hope for you all goes well and that you will be blessed with a healthy little boy!

all the best and good luck,
patrick..