Melbourne dry eye sufferer (partial blink and MGD)

[Peatear3]

Hi all,

I've been quietly reading the boards on and off for a few months now, and thought I'd start to join in and say hello.

I had an upper blepharoplasty over 6 months ago and as a result, I'm suffering from partial blink, lagophthalmos (at least the nocturnal kind) and mild-to-moderate MGD. I am undergoing treatment under the supervision of an opthamologist in Sydney.

A quick list of treatments I've tried:
- FML steroid drops for three months, but they haven't seemed to help so have ceased using this at my doctor's advice.
- Dissolvable punctal plugs (lower ducts only).
- Permanent punctal plugs (lower ducts only), which caused a great deal of redness and a concerning irritating sensation so were quickly removed. I'm now wondering if I could try differently shaped plugs which are less irritating.

My current regime includes:
-TheraTears Nutrition softgels x 3 per day
-TheraTears Liquid Gel (thinner drops feel like they're useless)
-Lacrilube (both day and night, when the Liquid Gel irritates my eyes too much)
-Blephasteam x 2 sessions per day (just started)

If anyone has any tips for me based on my issues above, I would love to hear from you. For example, does anyone have experience of recovering from prolonged dry eye after a blepharoplasty? How was this achieved? Was it just a matter of time (months, years) before the eyelids closed? What I would really want to avoid is another operation (e.g. skin graft) to enable eyelid closure - nothing frightens me more, knowing just how spectacularly operations can be botched.

Notably, my dry eye has arisen from both a mechanical issue (incomplete eyelid closure) and a functional issue (MGD).

[DCRdryeye]

Hi Peatear,
I reside about 3 hours from melbourne. You may wish to visit a site my colleague and I put together www.australiandryeye.webs.com and if you're travelling to sydney for treatment you may have discovered (as did we) that Melbourne ophthalmologists are not very useful in treating dry eye.

I recently had MGD probing by a top dry eye ophthalmologist in Qld, pvt me for his details.

Surely you could find a cosmetic surgeon to create complete closure? Or unless the skin continues to sag with time and it closes naturally? I assume you where a sleep mask at night?

MGD is currently not curable, but can be managed and in fact, if not managed will get worse. So it's good you're using Blephasteam and taking action on the condition.

[Peatear3]

Hi DCRdryeye,

Thanks for providing this link, I am grateful for any information I can get my hands on. (I've started reading the information on your landing page with a help of screen reading software that I just installed!)

While it may be possible to finding an occuloplastic surgeon to perform a revision, my initial research has indicated that re-operating is considered a 'last resort' given the complexity and high risk of complications. Dr Jim Kokinnakis of The Eye Practice, who I saw last week, was confident that my eyelids would close eventually, although he said it was unclear as to just when this might happen. In the meantime he provided me with blinking exercises that he said I should do at least 5x per hour, which he said would speed up the process. He said in about 6 months time, I might want to consider seeing an eye surgeon he said was "the best" in Sydney... just to have that initial conversation. With blepharoplasty a patient would usually want to wait about 2 years before re-operating since it takes a long time for the internal tissues to sufficiently recover.

I use Lacrilube at night, getting up half way in the middle of the night to re-apply it. I tried clingwrap with an eye mask for a while but the Lacrilube seems sufficient. I've read some of the concerns about Lacrilube on this site but so far it's the only thing I can find in Australian chemists that seems to the do job overnight. I'm finding that gels tend to crust up and start scratching my eye, and they evaporate too quickly.

Glad to hear that Blephasteam gets your endorsement. It's expensive but I think it's helping a little already, and like many, I am desperate to get back my functionality given my TBUT of 1 second...

[DCRdryeye]

Hi Peatear,
It's 3am and I've been at my mothers 64th birthday function and I video taped and took photos. Normally, such an activity would not be possible and I was able to go without my moisture chamber glasses for 6 hours...a feat that was impossible 6 months ago. All I needed during the long night was a drop of hyaluronate a few times. In fact, normally I'd be in pain without my moisture chambers within 10 minutes. So what I'm doing seems to be finally providing relief after 6 yrs of this dreaded disease.

Dr. Kokinnakis is highly endorsed by us at Australian Dry Eye. I'm not sure who he is referring too as an eye surgeon, was it Dr. Colin Chan? I'm having a procedure with him for partial cautery in December. The problem is that in Australia there is no definitive Dry Eye Clinic where you can get "the lot" done. So it's a matter of seeing several ophthalmologists, optometrists, etc and treating at different angles. Since this disease is multi-factorial in it's etiology, that's how the treatment needs to be.

The exercises Dr. Jim gave you will help stretch the skin more quickly to give full closure. He's a very smart man. Perhaps leave any attempts with surgery and simply allow the treatment to be "time" along with the exercises and gradually you'll improve.

Furthermore, the MGD may not be a separate issue. If you have a lack of Lacrimal secretions (Aqueous Deficiency) from Blepharoplasty, that can trigger MGD and vice-versa.

[spmcc]

I've heard about weights for the upper lids. There were stick-on and, of course, surgically implanted. You could search DEZ for more info.

Good luck.

[Peatear3]

Hi again DCR,

That sounds like a drastic improvement indeed. Your previous reliance on moisture chambers sounds close to what I'm experiencing right now.

Thanks for the tip about the drop that works for you - it's prompted me to do some research on it. How long did you have to use the hyaluronate before you saw results?

The oculoplastic surgeon Dr Jim recommended for me was Raf Gabrial (http://www.drghabrial.com). I didn't see anything on the website explicitly mentioning that they could fix my problem, but I've yet to give them a call... and of course I'm sure their procedures extend beyond what's given there as key examples.

Along the lines of needing to shop around for different approaches, I found Dr Jim as a result of some reading I did on the LipiFlow device. Dr Jim didn't think I was suitable for LipiFlow due to how much it stretches out the eyelids. But for anyone who's interested he said last week he's got the LipiFlow device back in again (but I'm not sure for how long).

I'm actually really fascinated by the information you have on your website about AMX - have you given this a go yourself? Are you aware of a Melbourne-based surgeon who has ordered the stuff in? I'm particularly interested because they said it could help people with incomplete lid closure. In particular, I'm asking because I'm a little concerned about the fact that I may well be put on Restasis as the next course of treatment, having read about the common side effects, low success rate and 6-month (?) waiting period before seeing results.

[Peatear3]

I've heard about weights for the upper lids. There were stick-on and, of course, surgically implanted. You could search DEZ for more info.

Good luck.

Thanks spmcc. This seems like a less invasive form of surgery - I'll take a look.

[DCRdryeye]

Hi Peatear,
Yes I know Raf Gabriel and have consulted him myself several years ago when I was very distraught after having had a DCR operation for epiphora. I wanted him to "reverse" the operation since it was causing dry eye. I will not mention more about him since doing so will get me into trouble on this forum. But I'm sure you get the picture. You'll notice he's not on our list.