24yr Canadian Dry Eye Battle

[dryeyesandchocolate]

Hi everyone!

I am a long-time lurker of this website and so far it has been incredibly insightful for me. This is my first post so I'll try to keep it brief, but as we all know, there are no short dry eye stories

I have been a contact lens wearer since I was 13 (just over 10 years) and never had any major problems. Of course, after 16+ hours in my lenses I would get dryness or heaviness, but nothing out of the ordinary. Last year, I took my first full time office job and noticed my eyes getting more and more red. The dryness is a sensation I noticed, but redness was what bothered me most. That was almost 1 year ago and now I have completely stopped wearing my lenses and switched to glasses full time. I recently visited a dry eye specialist in Toronto who said I have lots of inflammation and irritation as well as a small callous on one upper lid, likely from my contacts. I used Lotemax for 2 weeks so he could see if steroids would help. Although they did not solve the problem, my eyes improved probably 50%. So now I am one month into Restasis and 4000mg of very high quality omega-3s.

My eyes are back to redness (Lotemax helped redness a lot) and I also noticed my vision seems a bit off? My eye doctor checked my eye pressure and said I had no issues but has anyone experienced a prescription change with dry eye in a short period of time? It's nothing major but it does affect my vision a bit

Things that help me:
- cold compresses help if my eyes ever feel puffy or swollen, which happens maybe once every few weeks for a day
- I'm trying to drink tons of water and eat healthier, although I'm already very health conscious
- Hylo and Systane eye drops, as needed during the day

Things that harm:
- the months of Nov to April are TERRIBLE in Ontario for dryness. I run a humidifier in my cubicle and also at home
- lack of sleep = major redness
- I am a "bad blinker"

I would love your tips for:

- bad blinking!! I am a half-blinker, which is probably the most difficult thing for me to treat/manage. How can I train myself to fix this!?
- office tips for dryness
- dietary tips

Thanks everyone who posts on here. It's such a relief to know you are not alone, and there are so many resources out there!

Talk soon

Lauren

[pythonidler]

Welcome to the forum. I'll give you my opinion regarding blinking and managing the office environment a little later in this post, but I have a few questions first:

1. Have you noticed whether computer use has made your eyes worse? One way you can test this is to spend a weekend outside and away from computer and TV screens. This was something I discovered fairly quickly after my first dry eye symptoms. I think it was this in combination with long-term contact lens use that caused my dry eye.

2. You said your doctor noticed irritation and inflammation in your eyes, but has he diagnosed you with anything specific? (e.g, meibomian gland dysfunction or tear deficiency)

3. Are you continuing to use Lotemax, and if so how often? I use Lotemax as well, but only 2x/week. As you mentioned, using steroidal drops such as Lotemax may increase your eye pressure long-term (not a good thing).

The reason I'm asking these questions is because I think it's super-important that #1 - you figure out what caused your dry eye so you can avoid doing those things in the future (sounds like you've already figured out contact lenses are a no-go, so that's good), and #2 - you find a good doctor who understands all of your eye problems and can focus your treatment to address specific issues (on this point, there are a lot of ophthalmologists out there who might say generic things like "you've got a lot of inflammation in your eyes" and only prescribe Restasis. Avoid these doctors like the plague.)

As for the tips:

Blinking - allaboutdryeye.com has a good overview of what blinking exercises to do. Basically, you squeeze your eyelids shut for a few seconds, and repeat several times over the course of the day. I used to have a reminder at my work computer to do this. You can install a Chrome Extension called eyeCare to remind you to do these blinking exercises.

Office - The most common advice I've heard for offices (besides installing a humidifier at your desk) is to just take computer breaks. Follow the "20/20/20" rule, which means that every 20 minutes you should take 20 seconds to look at an object 20 feet away. Some people on this forum also use moisture chamber goggles. The Dry Eye Company (which Rebecca, the owner of this site, is involved with), has selections of glasses and goggles which are designed to shield your eyes from the environment.

Diet - The only dietary advice I would offer is to take omega-3 supplements such as Nordic Naturals, but it looks like you're already doing this. One ophthalmologist told me to go on the Paleo diet for a month. That was a really hard month for me. Besides being an incredibly difficult diet to follow, it also did no good for my eyes.


I'll leave you with one last thought in my long, rambling post: Consider what's really best for your eyes in the long-term. If office work is making your eyes worse because of all the computer use (and you will need to confirm it is actually the computer that's the problem), no amount of blinking exercises will really help, IMO. It's possible you could be comfortable for a few years, but personally I know I couldn't do it for another 35-40 years (I'm 30 right now).

Good luck, and keep us updated on your progress.

[dryeyesandchocolate]

Hey pythonidler, thanks for the reply!

Yes, computer and office environment in general seems to bug my eyes. Weekends away from screens do help. I actually got a new pair of glasses with the blue light blocker to help while I work on my computer, and so far I like them. I'm trying to spend less of my free time on screens like my phone, etc. I've started reading more physical copy books rather than on my iPad which I'm hoping will help. Looks like I need to invest in a big book shelf

My doctor didn't outright diagnose anything specific, although he narrowed it down. He said my glands secrete oil that looks pretty healthy (not too thick, not clogged). He wants me to improve my tear film, with the omega-3s and the Restasis, but otherwise nothing specific. I have no diagnosis of Blepharitis, ocular rosacea, or others. I do have terrible seasonal allergies and this year in August they were absolutely brutal. This is when my eyes got very red and irritated and it kind of never went away, so I believe that's what really fueled the irritation.

I've stopped using Lotemax completely and to be honest, I would like to keep it that way. I don't like the idea of using a steroid forever and prefer a more natural approach if possible. I know it may not be realistic but for now, that's my hope.

Thanks for the Chrome extension tip. I will look into that today! I will work on the 20/20/20, which I am admittedly terrible at. My goal is to become a highly ranked Executive someday so I can have my own office with big windows I can open and create my own nice work environment haha!

Diet, I feel like is a constant work in progress. I also tried Paleo, and typically follow this diet loosely anyways. I am pretty healthy, but of course there is always room for improvement.

Thanks so much for your help! I will post any successes I have

[pythonidler]

Just so you know, I was in a very similar situation when I got my first dry eye symptoms. I was young (25), had worn contact lenses for a long time (11+ years), and had been working at home at a computer. Over the next two years, my eyes gradually got worse and worse as I worked at an office job requiring a lot of computer use. My eyes got so bad at the end of the 2 years that I had to quit my job.

I believe that office job did far more harm than good - if I had quit before I started, my eyes might feel "normal" right now. But the 2 years of office work did irreparable damage to my eyes, and now I will probably never feel "normal" again.

While I'm not telling you to quit your job (at least not right now), you should at least consider the career path you're on. If computer work makes your eyes worse, then why commit to another 30 or 40 years of computer use? In just a year or two, your eyes could be much worse than they are right now. Think about it and consider other career options, if possible.


As for your doctor, I'm a little worried he hasn't diagnosed you with anything specific. Still, give him a few months to make you better. But if you're still feeling bad by, June, let's say, then you should probably move on from your doctor. Has your doctor taken images of your eye with LipiView or some other technology? If not, this is a warning sign, IMO.


Regarding the Lotemax - since it sounds like this has really helped you, I don't see why you should stop taking it altogether (unless your doctor has specifically said you shouldn't). I trust my own doctor when he says 2x/week is enough to provide a benefit but not enough to cause harm.

[farmgirl]

Try setting a time for the 20/20/20 as a reminder, we all have a cell phone handy

[dryeyesandchocolate]

Wow, pythonidler our stories sound similar. I have a fear of my eyes getting progressively worse but that's why I'm giving the Restasis and high dose Omega-3s a shot. Can you tell me what exactly caused you to quit, in terms of eye symptoms. Was it dryness to the point of paint? Irritation causing squinting and watery eyes? Redness? Right now my eyes really don't feel terribly dry, more irritated and sometimes difficult to focus after long hours on the computer. I have no idea how to change career paths as I'm doing what I love and have big dreams. What kind of jobs these days don't have computer work!?

Anyways thanks for your help so far. The conversation is very valuable to me!

Farmgirl, thanks for the tip! I downloaded the eyeCare chrome extension yesterday and LOVE it!

Thanks all

[pythonidler]

My initial symptoms (about 2 months before I started my office job) were very mild. I had just a general feeling of dryness - no irritation, no redness, no watering. But as I mentioned, my symptoms gradually got worse over the next two years.

Here's a short timeline of what happened, relative to the beginning of that office job:

7 months: I saw my first ophthalmologist, who prescribed Restasis. The only evaluation he did was look at my eyes through a slit lamp. He didn't do any other tests or take images of my eyes (e.g. Lipiview).
13 months: Because I saw no improvement with my first eye doctor, I started to see my 2nd ophthalmologist. He took me off Restasis and diagnosed me with MGD. Over the next few months, we tried a variety of things such as: Lipiflow, Hydroeye (flaxseed oil supplements), and Doxycycline.
18 months: This is where things really started going downhill. My eyes started to feel gritty. The grittiness sensation only got worse over the next few months.
23 months: I quit my office job. My eyes were super gritty at this point. I started looking for second opinions.

Looking back on what happened, I made three major mistakes:
1. I didn't see my first ophthalmologist until 9 months after my initial symptoms. The optometrists I saw knew very little about dry eye.
2. I assumed that any "regular" ophthalmologist would be able to treat dry eye. I have since learned that there aren't a whole lot of doctors who specialize in dry eye, and there are even fewer who are truly competent at treating it.
3. I stayed in my office job too long. Perhaps I should have quit before I even started.

From seeing second opinions, I eventually learned that I had two other problems besides MGD: tear deficiency and corneal neuropathy (nerve damage). It's my opinion that I started out with MGD and developed the latter two problems while at my job.

The reason I think I developed tear deficiency while working was because of my second ophthalmologist. When I first saw him, he used Lipiview to view my tear film. While Lipiview is generally used to look at the quality of the tear film (e.g., whether there is a good oily layer on top of it), it can also be used to view the thickness of the tear film. When I initially saw my second doctor, the thickness was around 100 nm in both eyes. Over the next 2-3 months (after I stopped using Restasis), that number gradually went down to about 60 nm in both eyes. I think stopping the Restasis caused tear deficiency and reduced the thickness of my tear film.

The reason I think I developed corneal neuropathy while working is because the grittiness that I felt is commonly associated with corneal neuropathy. It is probably not a coincidence that the grittiness (and corneal neuropathy) showed up a few months after I stopped taking Restasis. This is because fewer tears means there are less nutrients (such as Vitamin A) being supplied to the eye via tears, which leads to corneal neuropathy.


I guess the point I'm trying to make with this post is that your eyes can get worse under the right circumstances. If you have a doctor who can't really pinpoint the problem with your eyes, if you work at a computer 8 hours a day, then your eyes will probably get worse. The good news is if you do something about both of these factors, you can help yourself get better. But I'd like to emphasize - I'm not telling you that you should dump your doctor and quit your job today - just consider that at least one of those things will have to change if you don't get better. And if your eyes get worse, you will know that one of them needs to change.

[farmgirl]

Pythonidler, you say you developed the neuropathy due to lack of nutrients to the cornea. Had you or have you since) tried serum tears? Every time I went to a Dr. before I started the serum tears I had dry spots on my corneas. Since then I have not ever had an incidence of dry spots and that is with 2-4 annual exams and over about a 4 year period. If you guys are not on them I highly recommend you get them made up if you are in a position to do so.

These drops do not moisturize the eye but rather provide the precious nutrients necessary to maintain the health of the cornea. The last time the corneal specialist examined my eyes he told me that he didn't believe I would ever have a problems with my corneas even though when I first saw him and they did the Schirmers test my eye was so dry that it pulled the skin off of my eyeball when the paper stuck.

[pythonidler]

Hi farmgirl. Yes, I've been on serum tears for over a year now. They have helped tremendously and my nerves are probably 95% healed.

However, I wonder if they would have been necessary if I had kept taking the Restasis.

[farmgirl]

Wonderful, I am happy to hear that you are ever so much better. Who knows if it would have made a difference, the important thing is that it helped and has pretty much resolved that part of your problem at least.

[PG]

You can use www.protectyourvision.org for the computer break reminder.