post relex smile and eyestrain

[buiduyt]

Hello all!

I am 28 years old and I had relex smile on both eyes 5 years ago (June 2012). I have been reading around dryeyezone for quite sometimes. The moment I learn the existence of this site, I have felt a great sense of companionship. Even though I am not active in the forum (my eyestrain condition doesn't help apparently), knowing that there are people struggling with issues similar to me has made me a lot stronger and determined to overcome these difficulties.

I come from a developing country in Asia, and had my operation done there also. Eversince, I have experienced a lot of eye strain, headache and dryness.The humidity in my country (which is often 90% plus) is a big advantage to keep my eyes not as dry but the sun, the heat, the wind doesn't help. In fact, walking under the heat, bright light and stickiness isn't a comfortable feeling at all - unlike some members in a cooler geographical regions imagine.

My vision as I checked in February 2017 is 1/10. I have been prescribed with glasses of -0.5 and -0.75 but either prescriptions give me immense headache and eye pain so I have never wore them after surgery.


I have always thought that eye dryness is the main roots of my issues - at some point, for several months I was scared of going to sleep knowing that the next day will be very painful due to the dryness.

I had hot compress, lid therapy and had one doc performed meibomian gland expression several times for me (he performed some kind of staining/ dye before concluding that I need meibomian gland expression but I am not sure if it is corneal staining/TBUT or something else, how are these different btw? (1)), however he didn't find anything in particular seeping out from the lid (supposedly there would be yellow stickiness oily stuff no?)... Does that mean my meibomian gland is alright? (2)

I had my Schimer test done once, the result isn't particular devastating, (but of course there is always chance that it wasn't done correctly) right eye: 25 mm; left eye: 10mm.

I regularly (once a month - 2 months) have keratitis and conjunctivis, or at least I think I do, with red veins appear on my sclera and around my corneal along wth a bulging sensation. These lasts approximatel 5-8 days. I wonder if that is due to dry eye? (3)

Lately, it seems to me lately that my eyes dryness did improve. I could go to sleep with minimal issues, I can last one day without eyedrops. However, another symptoms rise stronger than ever, which is the feeling of eyeball squeezing as I read 10-20 minutes (the pain intensifies if I keep on reading but decreases if I look into distance - however this is very annoying if you need to focus to anything seriously, I have tried in the past 5 years but still can't overcome this issue) - does anyone here report similar problems? I don't know if it is an effect of dryness or it is something else. One doctor suspect that I have accommodative spasm, she got me on atropine for 10 days but it took me 1-2 months to fully recover. During this period, I couldn't read, focus on anything up close or it will give me an immense headache, head spin and multiple tummy- turning sensation (i guess you can call it butterflies in stomach?), very bad nausea feeling. I was very sure that was due to the atropine drops I took but the doctor refused and said it must be due to my vesitubular disorder. Well, I do have these problems once in a while but these symptoms didn't occur when I read or see anything up close like after I got those atropine drops. Aren't those atropine's side effect anyways? But nevertheless, I came back for the last check up and the doctor came up with another diagnosis that I have convergence insufficiency. My nearpoint convergence is 10 mm and according to her I fit into the catergories.

Now I know that I have lots of questions and some of them don't even have to do with dry eyes (or it does but I have no clues) but since it is very hard to find a conscientious doctor around my area who can at least explain what they did to me during these examinations and its result, I hope you can help me to get a good first start and examine some of my questions. Perhaps give me an advice which exam/tests I should ask for? Then I can find the best solutions for my issues. Here are the questions again:

(1) how is corneal staining different than TBUT?

(2) If nothing seeps out of my meibomian gland during MG expression, does that mean it is alright?

(3) are conjunctivis and keratitis a common result of dry eyes?

(4) now that I know that I might have both dry eyes and prehaps convergence insufficiency, what tests should I ask to peform?

(5) Should I even ask those questions here? or should I post in the Open forum, I am quite confused!

Thank you!

[Hokucat]

Hi buiduyt. I'm not familiar with all of the things you mention in your post, but will try to shed some light on your questions:

1) Corneal staining uses a dye to detect any damage or abnormalities on the eye surface, like scratches or abrasions. TBUT checks how many seconds it takes to see dry spots on your eye surface after blinking. Typically >10 seconds is normal. <5 can mean you have MGD (glands generating little/no oil or poor oil quality, which causes tears to evaporate quickly). What are your TBUT scores?

2) Normal functioning glands should have clear, flowing oil, when expressed. Signs of MGD are if nothing at all comes out (that could mean your glands are totally blocked or not generating any oil), or If yellow/white/gray sticky or thick stuff comes out (the quality of your oil is poor). Have you been diagnosed with MGD?

3) I don't know first hand if conjuntivitis or kerititis is a common result of dry eye. I've only had conjunctivitis once since having dry eyes for the last 9+ years. My understanding is those conditions can result from either a viral or bacterial infection. Perhaps touching the eyes more because of dry eyes and not having sufficient protective tears makes dry eye sufferers more vulnerable.

4) I didn't know what convergence insufficiency was, but when I looked it up, this article below said it can be mistaken for dry eye. Have you been diagnosed with both or is it not definitive? This article lists some tests and therapy for convergence insufficiency, but it's not something I am familiar with.

http://optometrytimes.modernmedicine...y-eye?page=0,3

Glad you find comfort being in this forum. There's lots of good info here and people who want to help.

[buiduyt]

Thank you Hokucat!

Your answers are certainly helpful!

1/ Doctors in my area have been very ambiguous about all the tests they performed on me. To be honest, they don't always tell me what they did to me (they will consider me disrespectful if I ask too many questions) so I don't even know if they performed TBUT or corneal staining. (they both dye our eyes and look under slit lamp - no? ) Plus, we were using the a different language and even if they tell me the name of the test, I wouldnt even know if they are the equivalent of the english one. Resources for dry eye in my language are extremely rare. Btw, how about fluorescent dye test? is that the same as corneal staining? Usually how do you know if they are performing TBUT or corneal staining on you ?

2/ This is very interesting information! All I knew is that the doctor perform some kind of stain test on me, and then said he understood now why i said my eyes hurt.Didn't give me a diagnose. Then he asked me to subscribed to a lid therapy package - later on I realize it was actually meibomian gland expression (from the picture and procedure described in this forum). It was not him, but the nurse performed on me, and she said she didn't find anything that came out. All I knew is that it hurts immensely afterward, numb for quite a few days.

3/ & 4/ If not too personal, may I ask what kind of pain do you go through for your case? I always assume that most dry eyes patients go through what I experience, turn out not. I have conjunctivitis and keratitis ways too frequent (every month or 2 months) that I thought it was linked to dry eyes! I swear I don't touch my eyes so often - but I do notice that working long hours increase my chance of getting conjunctivitis.

I never have the stabbing sensation that many complained about but nearly all the times the soreness sensation. Very much similar to convergence insufficiency symptom, but the diagnosis was not definite. I am going to a new clinic this time to get another diagnose - now that I have a better idea what to look for, and what to request.

Thank you for the article you found, let me read it throuhg again.Let's hope that I won't get looks for my questioning attitude this time at the clinic!

[Hokucat]

Hello buiduyt. Yes, for both corneal staining and TBUT they put some drops/dye in your eyes and look at it under a slit lamp, so can see how it's difficult to tell which they are doing if you were conversing in a different language than English, and you can't ask a lot of questions in your culture! You should be able to tell when they are doing TBUT vs staining, because when doing TBUT they tell you to blink and then keep your eyes open (so they can count how many seconds before dry spots appear). Also, I believe corneal staining and fluorescein staining are one and the same, but am not 100% sure.

As far as what the pain was like when I used to have severe dry eyes - it's hard to describe, but it was like a constant major stinging feeling, so bad that I could not bear to keep my eyes open. Like someone pointing a laser into my eyes all the time.

So your diagnosis is likely MGD, if they did gland expression on you. Is it possible for you to request a copy of your records from that doctor? Then you can give it to your next doctor(s), and have a copy for yourself to hopefully use to confirm the complete diagnosis.

I'm not sure where in Asia you live, but if you are planning to fly to Singapore (per your other post), are you anywhere near Japan? Japan is very advanced in dry eye treatments, and have several clinics.

Scleral lenses are something you may come across and consider in the future. These have recently been increasing in use to manage dry eye symptoms. The lenses vault over your cornea to bathe them in saline, and the lens edges sit on the sclera/white part of your eye. I wear mines 12+ hours a day, and it helps a lot. This Boston PROSE scleral lens website has a good description of sclerals in general, but there are several different brands. I happen to wear PROSE and have been very happy with them and my PROSE doctor, so would highly recommend them. Not everyone can tolerate wearing the lenses, so you would have to go for a consult first to try on a sample pair to see if you are a candidate.

http://www.bostonsight.org/PROSE/PRO...y-Eye-Syndrome

Also diet can be key. Drinking fresh lemon juice in green tea was almost a complete turnaround for me. It changed my thick oils to flowing, so my glands no longer get blocked. Somehow this was something my body needed. For you, this or some other diet changes might help.

[MGD1701]

I often hat conjuntivitis. Good way is avoid it is
to wash eyes with warm waters say 10 times (perhaps during shower) to remove bacterias, dirts etc. and
warm compress, massage, lid scrubs with something can kill bacteria, like Ocusoft with hypochlorous acid 0.02%, twice a day.

Most of my doctors also do not tell me what they have checked and the results - if they do, very rough info - very annoying.

[buiduyt]

I'm not sure where in Asia you live, but if you are planning to fly to Singapore (per your other post), are you anywhere near Japan? Japan is very advanced in dry eye treatments, and have several clinics.

Thank you for wonderful information! I already looked into scleral lens and will consider it for future treatment as well.

Regarding Japan, do you happen to know any quality clinic? I am open to all options!


MGD1701: its really too bad that well-conversed doctors are rare to find. I always get records from my appointment but again, they are super rough information(even if they perform TBUT test on me, there was not record written down!), barely provided the information that I need.

[Hokucat]

You're welcome, buiduyt. Good you looked into sclerals for potential future treatment. If you go to Japan, perhaps it makes sense to go to the Nagoya Eye Clinic where they also offer the PROSE scleral lenses, so you can try on the lenses and see the PROSE-trained doctor there. This clinic is the only one in Japan that has PROSE. I think Dr. Kojima is the dry eye specialist there. I believe they also speak English at this clinic.

http://www.bostonsight.org/PROSE/PRO...e-Clinic-Japan

[buiduyt]

You're welcome, buiduyt. Good you looked into sclerals for potential future treatment. If you go to Japan, perhaps it makes sense to go to the Nagoya Eye Clinic where they also offer the PROSE scleral lenses, so you can try on the lenses and see the PROSE-trained doctor there. This clinic is the only one in Japan that has PROSE. I think Dr. Kojima is the dry eye specialist there. I believe they also speak English at this clinic.

http://www.bostonsight.org/PROSE/PRO...e-Clinic-Japan

Thank you! Let me check that out then!

[MGD1701]

Hi buiduyt
Your question: (2) If nothing seeps out of my meibomian gland during MG expression, does that mean it is alright?
NO, it suggests something wrong. normal should be clear oil seep out. You need to find out why?
glands are too clogged? oil too thick? BlephEx, probing, LipiFlow, IPL, omeg 3 would help.

S. Lense - only offer comforts. you still need to do warm compress, massage, lid scrubs to get oil running, if you have MGD.

viedo/lecture by Dr Korb, inventor of LipiFlow & systance Balance drop - might help you learn more.
https://www.youtube.com/watch?v=AYjB...g&spfreload=10