Dry eye or not dry eye....someone please help!!

[dbink]

This will be long and detailed because I'm hoping someone out there will be able to help.
I'm 49, female and had Lasik surgery 16 years ago. I was born with polar cataracts (which have never been a bother to me) after Lasik because of these polar cataracts my vision was 20/25 and 20/30
Over the last few years, on and off, I've had this 'thing' going on in my right eye. Its like there's a fog/blur/cloud/glob right in the center. This used to come and go and so I lived with it. My opthalmologist said he didn't see anything of concern so I wasn't worried.He did tell me that OTC eye drops might offer me some comfort, he did an eye strip test to check for dry eye, and he said I was borderline 'dry eye'. Eyes were still 20/25 and 20/30.
Then in December of 2012 I started to experience it again so because it was bothering me, I went in to see a different opth. at the same practice bc my regular opth. couldn't see me. She said I had PVD but that everything else was pristine. She sent me home told me not to worry. In February I became very frustrated and insisted on seeing my regular opthalmologist and when I went in he again said 'there is nothing wrong with your eyes'. Keep in mind this Dr. has a very high standing reputation in my city, he also performed cataract surgery on my husband last year. I do trust him.
At this time he sent me to see one of his colleagues in another city who is a cornea specialist opthalmologist. He did a comprehensive exam and did the dry eye test and said that I need to use OTC drops regularly bc of my age and being peri menopausal (not confirmed, but more than likely) he thought this would help. Said everything else was fine!!! Then I remembered we have a close friend who is an optometrist (now I know that an optometrist is not as high ranking as an opthalmologist) but I would go in there, telling him exactly what the others said and at least get an honest opinion bc the problem in my right eye was driving me nuts, and it was affecting my way of living. So my optometrist says, that I see better with the naked eye than I do with any of the lenses they tried with that machine that they use (the one they slide up to your eye and you have to rest your chin on)
He said he wants to treat me with Restasis because he didn't think it could be anything BUT dry eye.
My question to all of you is if this is truly dry eye, how can my problem only be in one eye?
SO I've been using the Restasis for 5 weeks now, and everything"s the same for me. The feeling of my eyes feeling dry is there and the Restasis does soothe, but the vision in my right eye has not cleared up. My instinct is to always blink that eye into focus but that does nothing. I wear reading glasses but the condition is the same at all distances. Also, even using the Restasis every 12 hours as the prescription says, I still feel dry throughout the day. I don't have pain in my eyes like some people have described on these forums. I am hoping someone on here can shed some light on this.

Oh and last but certainly not least, LIGHT SENSITIVITY. I've always seen halo's and starbursts around lights of oncoming cars since my Lasik surgery, but now I have light sensitivity during the day....UGHHHHHH

[chads38]

Hi,
Is there any chance that they could be floaters?
I ask this because for about 3 years after having iritis I was left with a large grey area of floaters it was like a curtain coming down and covered about a third of my vision ,it made my vision blurred and also made me feel sick and dizzy due to trying to see through them, also they seemed to absorb more light and I found it hard to keep my eyes open in even in weak sunshine. They now seem to have gone but my optician said they wont have it's just that my brain has learnt to ignore them.

[Rebecca Petris]

Hi there, coupla thoughts:

1) Since you know you've had PVD... have you read up on symptoms? Also I think chads may be right... floaters can be pretty odd sometimes, some people get great huge ones rather than the little highly mobile type.

2) Re: why only one eye for the dryness: It's quite common for people with dry eye to have one eye that is much more symptomatic than the other. Lot of possible reasons for that. But I would also check out the dry eye testing to see how it varied between the two eyes. I think it would be very unusual to have vision impact from dry eye in one eye only unless there's other factors like one lid doesn't close due to Bell's palsy or something... on the other hand it doesn't sound like any of the doctors think you've got any surface disease causing vision change anyway so it's probably moot.

3) Light sensitivity (daytime) is pretty classic with dry eye too.

4) Re: the following:

SO I've been using the Restasis for 5 weeks now, and everything"s the same for me. The feeling of my eyes feeling dry is there ... I still feel dry throughout the day.

Next time you have an appointment I would encourage you to get much more detailed diagnostic information from whoever you see. (By the way, optometrists can be just as good or better than ophthalmologists at dry eye - it all depends which one. Optometrists tend to spend considerably more time with their patients incidentally.) By diagnostic information I mean (1) get them to clarify to what extent you have or do not have aqueous deficient dry eye (i.e. lacrimal glands not putting out enough) versus lipid deficient dry eye (i.e. oil glands in the eyelids either chronically blocked or not producing enough). That makes a big difference to what treatments are appropriate. With aqueous deficient dry eye, common treatments are artificial tears, punctal plugs and Restasis, but with lipid deficient, most treatments focus on improving the oil glands with cleansing, warm compresses, antibiotics or other treatments. So get them to shed more light on this for you. Even if you're one of the small percentage whose tear production is increased by Restasis, it's no surprise you still feel dry if your oil glands aren't working (because your tears just evaporate too fast without the oil).

[dbink]

I think it would be very unusual to have vision impact from dry eye in one eye only unless there's other factors like one lid doesn't close due to Bell's palsy or something...

Its weird bc on the very rare occasion now that the glob/cloud is not there, I see fine but those moments have become rare. Could a PVD get worse, because like I mentioned in my post this 'thing' thats going on used to come and go. Now its pretty much constant. So that makes me wonder if it is indeed PVD, could it have gotten worse. Also, I paraphrased your comment Rebecca ....I think it would be very unusual to have vision impact from dry eye in one eye only unless there's other factors like one lid doesn't close due to Bell's palsy or something....just want to make sure I understand it, are you saying my vision shouldn't be affected in one eye if it is indeed dry eye?
With PVD I always thought it was supposed to move out of the way (float away) so the fact that its settled right in the center caused me to think that its not pvd
I am so glad I found this forum......its true that sharing experiences with others that actually know what you're going through is a great comfort in itself.

[chads38]

Hi dbink,
I have just found lots of helpful info on PVD at www.rnib.org.uk , it does mention disturbed vision, flashes of light etc and other symptoms.
Tell me, if you look at a white surface can you see the cloud/glob more clearly? also if you move your eyes up and down/side to side does the cloud move slightly?

[Rebecca Petris]

I went back and re-read your post dbink and I think I didn't clue in the first time to the fact that you - if I understand right - haven't actually been diagnosed with dry eye based on clinical evidence, have you? I mean the cornea guy and the optometrist just kind of took dry eye as a fallback position because there's nothing else to blame it on and you're in the right demographic category, right?

Also, I paraphrased your comment Rebecca ....I think it would be very unusual to have vision impact from dry eye in one eye only unless there's other factors like one lid doesn't close due to Bell's palsy or something....just want to make sure I understand it, are you saying my vision shouldn't be affected in one eye if it is indeed dry eye?

Yeah. I mean anything's possible, but it would be unusual enough that I'd be looking for a reason.

But the other reason I don't think that adds up in your case though is this: Dry eye that is severe enough to affect your vision that much
(a) HURTS (usually) - I mean you'd more likely be here telling us more about how uncomfortable you are than about your vision, and
(b) is OBVIOUS clinically so the doctors you've seen would have been more emphatic about the dry eye diagnosis and probably more aggressive on treatments. I mean for someone to walk in to a corneal specialist and only be told to use artificial tears, it seems unlikely to me that they have bad enough dryness to seriously cloud their vision (whether one or both eyes).
Keep in mind this is just a layman's view, nothing else. I can totally understand why they'd conclude dry eye if they're seeing nothing else. Unfortunately I'm clueless about PVD and the possibilities there. You might want to try Healthboards, chads38's link etc on that one.

[dbink]

Thank you Chad and Rebecca. Chad I will look at that site. Rebecca I am buying into the dry eye theory just a teeny tiny bit because when I forget to use the Restasis I feel a slight burning sensation, but never any pain. The 2 opthalmologists did the strip test for dry eye and stated that I was borderline, and moreso in the right eye.
Whats driving me nuts is this blur in the center of my right eye, some days its worse than others. I was thrilled to have found this forum because everyone is so kind and quick to respond and I felt like I was getting someplace with the similar symptoms. I go back to see the optometrist at the 3 month mark and again my opthalmologist in September. Any recommendations on what I should insist on?

[littlemermaid]

dbink, Can you explain what PVD is and what the symptoms are? When was your last visual field test and who organised that?

[LaDiva]

Hi dbink,
This is probably too simplistic, but I have a continual "smear" of vision in my left eye. It is mucous. When I wear goggles, I don't have it, so it is from having an unbalanced mix of tears, oil and mucous. In my case, not enough oil or tears, and that leaves a continual streak of mucous which impacts my vision. Not sure if this is the case for you or not. Best of luck to you.

[dbink]

littlemermaid a definition of pvd as taken from rnib.uk site (The eye is filled with a clear jelly-like substance called the vitreous gel. Light passes through the vitreous gel to focus on the retina. When the vitreous jelly comes away from the retina this is called a vitreous detachment.)
Its another word for floaters. I do believe I have PVD but the fact that they don't always 'float away' sometimes they remain right in the center of my right eye causes me such frustration