Looking for help! Feel like I know too much and too little at the same time!

[Jaybo]

Hi everyone,

I'll try to keep it succinct as I'm pretty confused.

Long story short I was on a course of Roaccutane which I cut short due to my eyes being unmanageable. They became pretty difficult to deal with after a few months on the course. I used all sorts of drops which helped at first. Then after a few more weeks my eyelids started sticking to my eyeballs in the mornings. I told my dermatologist and he recommended using eye gels, I did this for a week but they didn't help. I stuck it out with eyedrops before bed before lowering my dose and then quitting the course completely. This led to things improving for around 5 weeks, but then things took a sudden turn and I started waking up with my eyes stuck again, which was horrible. My eyes have been horribly gritty, red, bloodshot and burning ever since. no drops seem to help. In fact, no drops at all feels better for some reason the last week or so. But still horrible.

This is the point where I start needing advice.

When all of this happened, my dermatologist requested an appointment, during which, he told me that it is likely that I have damaged the outer layer of my eye. He said he did it once with a tree branch and it took three months of ointment, sometimes getting up in the middle of the night to let oxygen get to the cells, to heal. He said that perhaps the cells were trying to mesh, but that they were being ruined again in rem sleep.

I wasn't 100% on this diagnosis as I'd been uncomfortable enough to have done a lot of research, including on this board, and lots of people in the same boat point to deficiencies in the tear film, caused by the medication. (I don't doubt that these deficiencies could cause the damage. i only doubt that repairing the ocular surface will lead to me being symptom free so long as the dryness continues) I did however start using ointment, which has definitely helped to get me through the night.

I saw an optometrist, as recommended by my GP. His diagnosis was that my eyes may take a while to recover from the treatment and "it's cold outside". This wasn't much help. Apart from that, no dry spots etc. Just redness and very, very bloodshot. He also said a few glands were clogged.

I then saw another GP who prescribed a week of Chloramphenicol. Which made symptoms worse if anything.

I was referred to eye casualty and was looked at by an optic nurse. He said that he couldn't see any inflammation and asked me to come in again the next week. When I came in, the lady I saw didn't have any of my notes, so we wasted a bit of time. She was far less attentive, gave my eyes around a 2 minute look, and told me I have posterior blepharitis and that I should do lid scrubs and warm compresses. I asked some of the questions recommended on this board about MGD:

I first asked "is any oil present when you try to express my glands?" her response was "yes, exactly", (she was Eastern European and I have no idea whether my question was lost in translation). I asked to clarify "I've read that the glands can be ,not clogged, but in fact, not working properly after this medication, can you see any oil?" her response was "yes", but the way she said it made it seem like she wasn't listening or didn't fully understand what I was asking.

Anyway, my dermatologist requested that I have an appointment with him and the travelling consultant who visits the practice last night. In this appointment, both Dr's looked at my eyes. They told me to continue with the eye ointment and drops as necessary and that "time" would heal the issue and that it could take three months if not longer and they may not go back to being 100%. (a change from our first appointment/and also, at this point, it has already been a month since he last told me it would take three months).


The reason I'm worried about this, is because, having read what I have about MGD, the longer the glands aren't working properly, the more likely they are to atrophy altogether. I know a lot of people here are prescribed a short course of tetracycline or topical steroids to assist. I'm worried if I wait another few months before seeking treatment, under the premise that this might self resolve, I could be risking further dysfunction.

I feel like I know enough to question what I'm being told by the "specialists" I've seen, but not enough to know what to do.

I've just started paying more attention to compresses and lid scrubs, beyond that I'm taking thera-tears nutrition (have been for the last two months). I have tried literally all drops/gels but they seem to make me far more up and down, with more severe lows. No drops results in just a constant grittyness or burning. With drops my eyes seem to cycle between constant grittyness, feeling okay and burning but they seem to be much more all over the shop and the grittyness with drops is far more horrible than without.

I'm sorry to have typed so much, but I have been given so many different opinions that, when added to the research that I have done myself, It's really left me with absolutely no idea where I should be going with this.

Absolutely any advice would be appreciated. Should I be seeking doxycycline? Steroid drops? Plugs? I really don't know what to do. But the idea of waiting 3-4months simply hoping for recovery is horrible.

[waterbee]

Hiya, I'm not expert but it does sound different to many other story's I've heard because it sounds like you don't have dry spots on the slit lamp exam? It's encouraging to hear that they think
It will clear up too as usually the first thing a dry eye sufferer gets told is its chronic (not always true, and very damaging to our mental health at this stage!) So it's good your not being written off. Having said that, I'm still confused about your glands, and if your in any doubt I would ask for a report detailing there first findings, they all write these for there records and its perfectly ok to ask for a copy of this or the letter they would of sent to your GP.
Are you taking flax oil or fish oil? It would really boost your oil if it's on the low side, but may take months to get started.

[LaDiva]

I am not familiar with Roaccutane, but if this is what caused your dry eye I am hopeful that your problem will resolve after you have been off the drug for awhile. I would suggest being tested for allergies, and perhaps consider Ocular Rosacea as a culprit. (Especially if your eyes are inflamed.) When I have a bad bout with Rosacea, my eyeballs actually feel swollen, so on top of being red, there is no mistaking the sensation. If you have a high magnification makeup mirror and a flashlight, you can see how much oil is produced after using a hot compress and expressing the glands. If you are wondering whether or not you have oil, you might go the magnifying mirror route. If you have MGD, warm compresses can be key to keeping the glands open and avoiding atrophy, but you must be consistent and use them routinely. Best wishes to you. I hope that your problem abates, and agree with waterbee in that if you were not told your situation is chronic, that is a good thing.

[Jaybo]

Thanks for your input! I stopped the course back in October, which is my reason for such concern. It's now been three and a half months. Everything was going well until around the end of November, when my eyes turned gritty within about 48 hours and have stayed that way since. It's not something I'd ever experienced before all of this, so I'm not coping very well at all, seeing as it felt like it happened over night. It's making things incredibly difficult (which is a huge understatement). Yes, there are no dry spots, which is strange because they feel hellish all the time. They are very bloodshot, with a mixture of larger veins and also finer veins covering most of my eyeball, so I know it isn't in my head, because they used to be white. Despite the apparent lack of dry spots, the best they really feel is a chlorine type burn, like I've just gotten out of a swimming pool. The grittiness is the worst and feels worst in my upper lid, when I blink, or look up I can feel the sandy lack of lubrication type feeling. I've tried looking on a few occasions to see if I can see any oil being expressed, but I can't see anything at all.

Can anyone tell me whether a warm shower running on the closed eyes can provoke the same effect as a warm compress? I then massage my lids. At present, I don't have access to a microwave, so I'm trying to do my best using this method and also have a rice bag that I leave on the radiator. I've just purchased a new house so we still don't have everything straight yet.

To be honest, I'm a little concerned that there may be an autoimmune connection that the medication/stress may have kicked off. I have also been experiencing a lot of joint pain and part of the reason, in conjunction with my eyes, for stopping, was that I was, and still am, shedding a lot of hair. I've had a dry mouth, particularly at night, ever since and although my nose isn't too bad, a lot of my other mucous membranes are very dry. I've discussed this with my GP, and had a lot of blood tests, but everything comes back clear apart from a fluctuating Neutrophil count. I've been putting all of this down to post medication side effects up until now.

Sadly, I feel for everyone on this forum, because in spite of all the other concerns that I have at present, my eyes are by far and away, the hardest to deal with and the one that I am absolutely, most concerned with finding some relief to.

[savino]

.............

[waterbee]

my optometrist has dry eye and told me she doesn't use heat pads only the shower on her eyelids for 1 minute every morning then she rubs them to loosen the oil, her dry eye isnt to bad, she's only using drops 4 times a day so may not need the intense heat of a heat pads, but in the mean time until you get these i think its safe to use the shower, (how ever Savino may know more about this then i do as ive never read up on it and it sounds like she/he has)
there are other things you could use, such as tea bags (careful they are not to hot) if you have two on the go you can alternate them so you keep the heat up. there are also things like Blephasteam Goggles for Dry Eye, which don't need a microwave to work but are around two hundred pounds so not worth the investment at this stage.

it sounds like you've moved house recently? are you in a dusty environment or having any work done? these things can all aggravate or even cause dry eye for some.

interestingly enough i had issues with muscle pain just after my dry eye started,
it turned out to be unrelated - but my doctor did let me do a range of vitamin blood tests that can lead to muscle pain and can be connected to dry eye, such as Magnesium levels and vitamin D - if you didn't have these done i recommend asking your doctor. if they say no, the vitamin D one can be done by mail order for around 20 pounds if you do a search on line in the uk.

I was also taking a long term medication before my dry eye t started, i never felt they affected my eyes (just my mouth) so i was blissfully unaware while taking it for 4 years it can cause havoc with the lacrimal gland.
i stopped at christmas after being told about its effects - so far, apart from feeling like a nuclear spit bomb has gone off in my mouth i do not see any difference with my dry eye but my rheumatologist is very adamant that my dry eye will vanish "soon" (my case is different though as i've seen ophthalmologists separately who have told me i have an issue due to lack of oil in my glands which are not blocked just not producing and my eyes are very dry anyway when i pushed him for an answer he told me to just "wait" and was very calm and laid back about it all.
when you think about it though - fish oil can take 3-9 months to work, so im going to assume its going to be at least that length of time eyes take to start responding to any change by coming of the meds..
also one last thing - ive spoken to NHS consultant about dry eye who told me he believes stress can cause some cases of dry eye and he has seen people make a recovery when the element of stress is removed, especially when it comes on suddenly in a stressful situation (he thought mine was caused by stress too) . so there is always hope for all stressed out dry eye suffers out there everywhere.


ps sorry for my grammar writing on this kindle and its auto correct are awful.

[LaDiva]

Different doctors recommend different ways to use compresses and do expression. I've been told at least five different things with the latest being to use compresses at least three times daily for 10-15 minutes each time. To loosen the oil, gently pinch the eyelids all the way around the eye for about 10 seconds at each position and rub the lids back and forth between thumb and pointing finger. This works pretty well, and better than the other things I've tried. My glands are quite blocked, so the trick is to find something that works well for you. You might not need this much heat, time or coaxing. I found wet washcloths chapped the skin on my eyelids. The most recent eye doctor recommended using tranquileyes as they hold the heat longer. I haven't bought them yet, and am still using rice baggies. I do not think it would hurt to run warm water over your lids. Most of us do that every time we take a shower anyway, but I am not certain shower water is enough to clear the glands.

[Jaybo]

Thanks again guys. Yes, there certainly is a lot of information out there! This is probably the hardest part for all of us.

Savino, I agree with you about the natural oils on my eyelids. I tend to shower every night so I may cut down to every other night or less to see if it helps (As of Monday, I have a microwave, so I can use this for warm compresses).

Waterbee, thanks as well. I have moved house and we have been having a lot of work done. A lot of which, I've been doing myself so I know that won't have been doing my eyes much good. Even painting and the fumes involved will have not been helping. But before all of this, my eyes were incredibly resilient, so it would be odd for it all to be affecting me so much. I also spent a week away over new year, and my eyes were worse if anything. I have been wearing some safety goggles as and when required for working on the house, but they aren't air tight and have just really been protecting me from getting anything significant in my eyes, as I suspect that if I scratch them with a stray piece of sawdust or similar, the dryness will mean it will take a long time to recover.

I'm interested to hear your response about long term medication. I've read in multiple places, including on this site, that the medication that I was on can severely inhibit oil production in the eyes because that is it's action, it reduces oil production bodywide. For a lot of people, the effect doesn't have too much of an effect on the eyes, but for me it seems to. I have read reports of it affecting all layers, lacrimal functionality and mucous production as well. So I have no idea really, which may be causing the issues. All I have to go on is the latest eye doc appointment resulted in a diagnosis of blepharitis. I think that it's probably not the case and that my glands are simply shrunk, rather than blocked, and I have to pray that they recover. I'm just really searching to make sure that I do everything to give them the absolute best chance of recovery. I really like your theory that it could take 3-9 months based on how long it takes fish oils. I've been taking theratears for about 2 months now, and do feel they make a difference. I've also read that some people feel better after 6-7 months and up to a year after stopping.

I have the same issue with my dermatologist and the consultant I saw. They both just said the answer to this will be "time". And given what I've read about people suffering more or less permanently after the medication, it really isn't a comforting thing to hear. I feel like I want someone to try absolutely everything to make sure that we haven't missed anything before we just wait it out. Doing nothing feels like a last resort to me. And really feels like giving up.

I will look into testing for any deficiencies that I may have. I've read conflicting information saying my symptoms are the same as an vitamin A toxicity (Roaccutane is a derivative of vitamin A and is taken in dosages hundreds of times the safe levels). But I've also read that the influx of Vitamin A derivative, rather than genuine vitamin A, means that the body is actually vitamin A deficient. And I believe that both hypervitaminosis A and also deficiency, seem to exhibit the same symptoms, inclusive of dry eyes. I know that medications like this can cause all sorts of deficiencies as well. So I'll definitely bring it up with my GP.

On the stress front, If someone could reach in and pull the current eye/joint pain straight out, and leave me feeling well for once, I'd dance from rooftop to rooftop! So sadly, it's likely to be a self perpetuating cycle so long as the eye issues continue, as they are the biggest cause of my stress at the moment.

Thank you LaDiva. When I've used warm compresses in the past, I've just done it for a few minutes. However last night, I did a longer one and my dermatologist, who is also a practising GP said that the compress should be as hot as I can tolerate. I did a compress for about 7-10 minutes last night and when I looked in the mirror, my eyelids were red along with the bridge of my nose, browline and top of my cheeks. They stayed that way for a long time. My eyes also looked much, much more bloodshot, which was pretty horrible. I don't want to increase the inflammation there? Does anyone have any advice on this? I don't want to be doing more damage in the long run.

I've also read on this board that there is a theory that warm compresses and massage, for people who are under producing, can result in lots of oil being secreted and essentially wasted. Almost like squeezing a few days worth of body created oils out at once, meaning it takes a while to replenish. This just adds to my confusion as the eye doctor said I should do it twice a day, but having read about wasting the oils, I don't know what to do for the best. I have to say, my eyes felt a little worse this morning when I woke up. I also used a no tears shampoo for a lid scrub for the first time last night. It could be the theory that my eyes might get worse for a while after starting a regime because the clogged oils are coming out onto my eyes, along with all of their inflammatory agents. Or it could be the wrong method for me. Anyone know how long you should trial things like this for before making a decision?

[LaDiva]

I think your compress is too hot. Your dermatologist is not an eye doctor, but he is right in that a very hot compress helps some people. There are people who cannot use warm compresses at all, and use ice packs, which don't work at all for me. I quit using baby shampoo as it also caused problems with my skin and eyes. You must find what works best for you. I cannot say this enough times: different things work for different people and it is up to you to experiment. If your eyes didn't like so much heat, don't do it anymore. If you are afraid the oil will be compromised by expression, then don't do it. It seems you have read quite a bit and know a great deal, so you have a wide array of choices from which to choose. Best wishes. I hope that you will soon feel better.

[Jaybo]

Thanks LaDiva. I'm just desperate for some relief from it all at the moment. So when I try something, and it doesn't provide any immediate comfort, or makes things worse, I don't know what to do. Generally, when I try something new, I get my hopes up that this could be the answer, then when it isn't, I feel pretty lost and wonder if I'm not doing it right, or whether I need to do it for a longer term. I felt like my eyes were feeling marginally better at the beginning of this week. When I started the warm compresses and scrubs etc on Tuesday and Wednesday, my eyes started feeling worse. So I don't know whether it's something that I need to push through to prove that it isn't just an early discomfort for long term gain. Or whether it actually isn't for the best.

I don't have any visible inflammation, just my eyes are very bloodshot with constant grittiness and frequent burning. I've read that the inflammation isn't always visible and that things like steroid drops can help anyway? Does anyone know anything about this? I've seen an optometrist twice, an eye nurse and an eye doctor, as well as two GP's, and none have mentioned any prescription drops beyond chloramphenicol, which is OTC anyway. I asked the GP if there was anything on prescription and she said no, that OTC drops were all she could recommend. All the eye doctor has recommended was lid scrubs and warm compresses, which, as I've said, feel like they've made things worse over the past few days (I didn't do it yesterday as a result). I'm wondering if there is some inflammation going on, perhaps on the back of my eyelids from friction, which the warm compresses are just aggravating. I'm struggling to concentrate at work with all of this going on so I'm desperate to at least lower the discomfort. I have another NHS specialist appointment, but it isn't until March, which is a long time to wait. Especially when my previous NHS appointments haven't offered much. Has anyone had any luck with steroid drops when there hasn't been any visible inflammation beyond bloodshot and red eyes?

[LaDiva]

I totally understand Jaybo. I felt the same way. When I first had dry eye, I could not even relate because I had never had anything before that didn't go away. I hope that yours does. Maybe try Ocusoft scrubs and see if they provide relief. Also, just for now, get some goggles you can wear at home and/or at work. At least you will be more comfortable. If you haven't already tried Omega 3s, that is another possiblity. I use TheraTears Nutrition, but other people have used other things including flax oil, which does not work for me. I would not use steroid drops unless you absolutely must. As an added thought, the things that helped me were Omegas, goggles, compresses, scrubs, diet, plugs, and goggles always goggles. Also, there are tons of different drops, and they can help adjust the tear osmolarity which helps maintain the eye surface. TheraTears, again, work the best for me, but everyone is different. I had to keep trying different drops until deciding which brought the most relief. Hang in there, and hopefully you will feel better soon.
http://ophthalmologytimes.modernmedi...rent-eye-drops

[Jaybo]

Thanks again LaDiva. It's so good to hear advice from people who actually know. I know it sounds pessimistic, but I really don't think much of Doctor's opinions at the minute. It's so easy for them to say "go home, do warm compresses, continue with eyedrops and see how things go", when even in the appointment, behind your eyes, all you can hear is yourself crying out in discomfort. They don't understand that for weeks leading up to it, that appointment has been your one beacon of hope, the one thing that you tell yourself "I know it feels bad, but let's just make it to that appopintment and see what they say", there's part of you that always hopes that they'll look at your eyes, say, "oh, it's this", and prescribe something that will make it all go away in a few weeks. I'm always quite composed in the appointments and I always feel like the only way they'd understand is if I was to break down, a 28 year old, 6ft 5 guy breaking down in the surgery, as though that would finally convey the situation. Instead, I feel like a cat in a bag, that struggled like crazy at first, and then decided to just go limp and pray that something happens to save me, and that's the attitude I take into the appointments. I'm worried if I take a more pushy stance, they may get fed up of seeing me and may be even less helpful.

I have been using Theratears Nutrition for around three months now, and have been using Theratears drops on and off for the past few weeks. Everything seems to fluctuate so much that I honestly don't know what helps. My eyes were so uncomfortable over Christmas that I kept putting drops in and if anything, my eyes felt worse. And I tried a lot of different drops. The only thing that provided some relief was Genteal gel. But even that seemed to have the downside that my eyes would feel uncomfortable for about 10-15 minutes after I put it in, then they'd feel okay (not great) for about 45 minutes, then they'd feel quite horrible. if I put drops in again at this point, then I'd repeat the cycle. However, if I waited an hour or so after this, they would calm down and become a mild burning/discomfort, which is more tolerable than the up and down gritty/burning nature of keeping on putting the drops in.

I actually decided to try not putting drops in at all a few weeks back, and for a week my eyes felt like they were getting a little better (although I was quite busy which may have helped my eyes by keeping them looking at different things rather than trying to watch TV or use the computer or drive etc). This made me think that no drops was the way to go, maybe my tears were such low quantity that drops were diluting them too much. But alas, even this then started to be uncomfortable.

There's a part of me that feels like getting goggles will push me (mentally) even further from the norm. And might be the final symbol that would make me feel like this is something I have to learn to live with. At the moment, I'm having a really hard time coming to terms with how much all of this is affecting me. I've had some other health issues (stomach and joints) that have already pushed me out of my old, 5-6 times a week, exercise routine. I used to finish work, then get to the gym or go and play sport every day. Now, with my eyes and other stuff, just getting out of bed is difficult, when I can feel my eyes burning before I even open them and I ache all over. So my life has already changed so much in the last year. I already sleep with ointment in my eyes, which makes me sad because I feel like I'll never accidentally doze off on the sofa, or on a sunbed on holiday again, without the terrible fear of waking up with my eyeballs stuck to my eyelids. I also feel like wind and air doesn't seem to make that much of a difference to my eyes. They feel horrible all of the time. If anything, a bit of a breeze on them is cooling. So I can't tell whether goggles would be of much help.

I'm due for some blood tests in a few weeks time that will test for a few things. I imagine the normal, eye affecting, things will be there (arthritis, sjogren's, lupus etc). As those things take a long time to diagnose, if they ever are, I'm not holding out much hope. I think my ana score was fine last time and no inflammatory markers.

Sorry for the long post, i feel like it helps to write all this out from time to time. And in a way, if things improve, or even if they don't, it'll be useful to be able to come back here to see how things were.

Out of curiosity, what is the issue with steroid drops? I have yet to try anything beyond drops and compresses/massage yet really.I know they can increase pressure in the eyes, which is bad, but that's only if taken long term if I'm right? Are there any issues with short term courses to try to calm any irritation down?

Thanks so much again.

[savino]

................

[LaDiva]

You are welcome Jaybo. I keep checking back here to see if you are feeling any better. Here is an article about steroids:
http://www.reviewofoptometry.com/con...essonid/107248

Steroids are probably OK for short-term, but as you said, there can be side effects. My eye doctor told me that they can cause glaucoma and blindness if used over prolonged periods. He doesn't like using them, but again this is a personal choice. Good luck with your blood tests. I hope they come back negative. I know what you mean about the goggles as I resisted for the same reason. When I finally started using them, I felt so much better. If your eyes are extremely dry, the surface of your eye will suffer and this is one good reason it is important to seal your peepers in goggles. Even if you only wear them at home in the evenings, at least you will be comfortable for awhile, and your eyes will have a chance to rest. My eye doctor at Stanford told me to be sure and use some type of eye drops as they help protect the eye surface. Perhaps you are allergic?

You might also consider experimenting with your diet, especially if you suspect Rosacea. I see you are English. My grandmother was born in England, and I've read that Rosacea is sometimes called "the curse of the Celts". Hah! I never knew one could have it in their eyes until I got it in my eyes. It is the pits. Dry eye with all of the trimmings, and then food limitations as well. I'd love to just have dry eye and still be able to eat chocolate cake and drink vino. If you want to try experimenting with food as a possible source of your inflammation, here are some food lists:

Rosacea food list: http://www.rosacea.org/patients/materials/triggers.php
Histamine food list: http://www.michiganallergy.com/food_and_histamine.shtml

I must avoid foods on both lists, and cannot eat any type of dairy. Instant inflammation. Best of luck to you. I am truly hoping you will find some relief soon.

One final thought about treatment and diagnosis: I don't know much about the med system in the UK, but consider finding a doctor who also teaches at a school of ophthalmology, as they tend to be more up to date with regard to treatment and dry eye. Some colleges in the U.S. have divisions that specialize in dry eye, so I am thinking you will get a more thorough check and diagnosis if you can find such a doctor.

[Jaybo]

Thanks again LaDiva. I am indeed English! and at the mercy of the NHS which is a case of "you get what you pay for" really, meaning a lot of very long waiting times if you have anything beyond the common cold. I am considering sorting my diet out. I used to eat very healthily because of all the training I was doing. I'd obviously have the occasional blow out meal, but on the whole, it was a very balanced diet. Lately, with some of the stomach issues I've been having, my gastroenterologist recommended a low fibre, high fat diet, to help things move through a bit more efficiently. I was eating incredibly low fat and high fibre for a while, and it really made a mess of my stomach. But as it was what had been recommended (Dr's thought I had gallstones), I persevered and it made things worse. The day I was told that I should be eating low fibre and more fat, I went and had a McDonalds, and actually felt quite a bit better, so since then, my diet has been pretty awful to be honest. Not all my meals are bad, but I seem to snack on junk a lot and have a lot of cravings for rubbish. I think this is mostly down to the depression that the other symptoms are causing. It's possible on that front that it's contributing. But again, I'm at that stage where I feel like I'm removing one more thing that I enjoy and making myself even less recognisable to myself.

When you say instant inflammation from those foods, do you notice redness and burning immediately? I find that when I eat at the moment, the additional saliva and secretions actually makes my eyes feel more comfortable (although even the effects of that seem to be lessening of late).

Also, how does ocular rosacea manifest? I don't have any visible signs of inflammation on my face or eyelids at all. The only visible symptom that I have of all of this is very bloodshot eyes (fine veins across most of my eye along with larger ones) and redness in the typical horizontal band that is associated with dry eye. The area that I can see when I pull my eyelid up or down, the surface of the eye is much whiter, although still interjected with lots of veins. The exposed area of my eye is the worst part though. I have seen two specialists and my local optometrist twice and none have mentioned anything about ocular rosacea. In fact, I don't believe anyone was able to find any form of inflammation at all.

There is a dry eye centre in London now, which is about an hour on the train for me. However, the consultation fee alone is £250 ($350) and that is prior to any treatments. So I have been holding off for the minute. Especially as I thought i saw an improvement a few weeks back. I recently bought a house and the only savings that I have, I have been putting away for a ring... (I hope my gf doesn't read this! although we've been together a long time so I know she will be expecting it!). Again, that pessimistic part of me still says that I've had no luck with doctors of late, so I'm hesitant to pay more money to another one. Especially one who has a bias towards finding something because that's how they make money. I know that's a gloomy outlook, but I really have seen a lot of Doctors and it seems like they all have differing opinions, which makes me lose confidence in them. So again, that pessimistic side of me says that there are so many opinions, who's to say that the next Doctor's opinion will be right, just because I like it the most.

If it continues at this level for a few more weeks however, I know that it's something that I'll have to do.