Sinusitis following Lasik eye surgery in 2011

[Stressed Steve]

Hi all

This is my first post on this forum. I was looking on the web hoping to shed some light on my symptoms and this post - http://www.dryeyezone.com/talk/showt...ight=sinusitis by rampage76 seemed to hit the spot.

I don't know if the nature of the pain has changed since the Lasik op 2 years ago, but I am now pretty sure that the pain is caused by lasik/dry eyes/sinusitis (oh, what was wrong with just wearing glasses?!).

After the Lasik, I knew something wasn't right, but couldn't really identify what. I visited specialist eye clinics in London who gave my eyes a clean bill of health (on one level, ie in terms of improved vision, the op was a success!). And having read some of the posts on this forum, I'm surprised that none of the specialists ever mentioned a possible connection between the surgery and sinus pain, although perhaps, it is not in their interest to do so.

Anyway, I have since explored treatment options with my sympathetic doctor, and have so far tried botox (got rid of a few lines, not much else), saw a couple of neurologists who diagnosed 'chronic tension headaches (wrong!), migraine meds (felt queasy), and a Avamys nasal spray (steroids, which helped for a bit, and then no longer).

I have finally swung an appointment with my local ENT clinic in a few weeks time and feel a lot more confident (in what I am saying) following the information on this website. So thanks!

[Scout]

Hi Stressed Steve,

I am really pleased that an old thread that I participated in has given you some help.

I just came across this amazing journal article that explains why our eyes feel dry and inflamed and the initial trigger is sinusitis or rhinitis. The link goes to the full study and the full article. I am posting the abstract below.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3712666/

Mediator profiles in tears during the conjunctival response induced by allergic reaction in the nasal mucosa

Zdenek Pelikan

Abstract


The allergic reaction occurring primarily in the nasal mucosa can induce a secondary conjunctival response of an immediate (SICR), late (SLCR), or delayed (SDYCR) type in some patients with allergic conjunctivitis (AC).

Objectives

To investigate the concentration changes of histamine, tryptase, eosinophil cationic protein (ECP), eosinophil-derived neurotoxin (EDN), leukotrienes (LTB 4, LTC4, LTE4), myeloperoxidase (MPO), interferon-γ (IFN-γ), and interleukins (IL-2, IL-4, IL-5) in tears during the SICR, SLCR, and SDYCR.

Methods

In 32 patients with AC, 11 SICR (p<0.01), 13 SLCR (p<0.001), and eight SDYCR (p<0.01) to nasal challenges with allergens (NPTs), the NPTs and 32 control tests with PBS were repeated and supplemented with the determination of these factors in tears.

Results

The SICRs were associated with significant concentration changes in tears (p<0.05) of histamine, tryptase, ECP, LTC4, and IL-4. The SLCRs were accompanied by significant changes in concentrations of histamine, ECP, LTB4, LTC4, MPO, IL-4, and IL-5. The SDYCRs were associated with significant concentration changes in tears (p<0.05) of LTB4, MPO, IFN-γ, and IL-2. No significant changes in these factors were recorded in tears during the 32 PBS controls (p>0.1) or in the ten control patients (p>0.1).

Conclusions

These results provide evidence for causal involvement of nasal allergy in some patients with AC, inducing secondary conjunctival response of immediate (SICR), late SLCR, or delayed SDYCR type, associated with different mediator, cytokine, and cellular profiles in the tears, suggesting involvement of different hypersensitivity mechanisms. These results also emphasize the diagnostic value of nasal allergen challenge combined with monitoring of the conjunctival response in some patients with AC.

[Stressed Steve]

Hi Stressed Steve,

I am really pleased that an old thread that I participated in has given you some help.

I just came across this amazing journal article that explains why our eyes feel dry and inflamed and the initial trigger is sinusitis or rhinitis. The link goes to the full study and the full article. I am posting the abstract below.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3712666/

Hi Scout

Thanks for sharing although I'm not sure my symptoms are related to an allergic response. Prior to the Lasik surgery, I had never had sinusitis and wasn't aware that I was allergic to much.
I also seem to have the symptoms from the time I wake up to the time I go to bed. There doesn't seem to be a respite, which again makes me thing it's not an allergic reaction.
I recently had my sinuses declared clear and "pristine" by an ENT doctor. He also said that dry eyes should not cause the other symptoms I experience on a daily basis (pressure behind the left eye, a dry catchy throat - which drives me mad incidentally - dry eyes, and sore nostril).

To gain relief I have tried various nasal sprays, eye drops, nasal cleansing, botox (!) but nothing has really helped greatly. I haven't yet tried cold compresses but they are on my list to try.

Steve

[Scout]

For me, it has always been my left eye as well. Pain in the eye, behind the eye, sinuses on the left side and if I don't treat it immediately, it will spread to the entire left side of my head in a migraine-like headache with light sensitivity and nausea.

Mine is not a typical or classic allergic reaction either. It is more in the Hypersensitivity area, which is more like a surface inflammation.

In my opinion, the LASIK surgery itself, the many eye drops we have used, the severe dry eyes, the surface inflammation--any and all of those things have left some of us with eyes/sinuses that are extremely hypersensitive and become severely inflamed quite easily and quite painfully.

Look up hypersensitivity reactions and what causes them and how they affect eyes, sinuses and skin. They are not typical allergic reactions but tend to be dumped into that category which confuses most people, including many physicians.

What works for me is an over the counter medication (that you need to purchase from behind the pharmacy counter) that reduces sinus inflammation and is used for sinus headaches. I use Aleve D, which is naproxen sodium and pseudoephedrine (Sudafed). But most cold brands now market a product like this with an NSAID and a decongestant/pseudoephedrine. For me, within an hour, it reduces the inflammation and the headache starts going away. I tried many different solutions and this the only thing that works for me.

The pseudoephedrine will cause dryness, but that is temporary and worth it to me to stop the pain.

Scout

[Stressed Steve]

Thanks for the info - I guess its all trial & error in terms of pain management.

By the way, do you know if there is also a link between lasik/dry eyes and a constant dry throat? I ask because I've had a dry throat for what seems like an age now.

[Stressed Steve]

Hi Scout

Can I ask if you had dry eyes or blepharitis before your laser eye op? I'm interested to know as your symptoms re DES & sinus pain are a close match to my own?
I'm struggling to deal with my multitudinous symptoms at the moment and am looking for answers.

Thanks
Steve

[Scout]

Can I ask if you had dry eyes or blepharitis before your laser eye op?

I have never been diagnosed with blepharitis.

I was diagnosed with dry eyes for many years. Many eye doctors over the years gave me wetting drop samples. I tried many but ended up feeling worse after I used them so I usually threw them away.

I also had a long history of allergic conjunctivitis and GPC (giant papillary conjunctivitis), an inflammatory condition that shows up as bumps and inflammation on the underside of your eyelids, usually triggered by irritants. My trigger was long term use of soft contact lenses. I ended up having to discontinue using contacts and in fact, that was one of the reasons I opted for LASIK. Bad decision . . .

I also had a history of autoimmune thyroid disease and was taking thyroid medication.

So . . . all of the above should have been reasons to be cautious about refractive surgery. Sigh.

I'm interested to know as your symptoms re DES & sinus pain are a close match to my own?

I really don’t know if our symptoms are a close match. I think there are similarities, though.

One thing I realized several years after LASIK: My eye inflammation, sinusitis and pain kept getting worse instead of getting better. Most of the drops that I was using to treat my symptoms (wetting drops, prescription allergy drops, etc.) seemed to help only temporarily and then over time, seemed to make the symptoms worse.

I look at sinusitis (for me) as an inflammatory condition, not as an exclusively allergic condition. I think now that the chemicals I was putting in my eyes for years were causing more inflammation long term rather than reducing the inflammation over time. I see it as chemicals being poured on top of an inflamed surface. Ouch. The inflammation can travel to my sinuses and inflame them as well. So I stopped adding the chemicals into my eyes. It was tough at first. But by using cold compresses several times a day and no drops at all, the inflammation started to lessen and I now have not used any kind of drop in my eyes for 5 years.

I really miss the prescription allergy drops for immediate relief. But I do believe that quitting them eventually improved my eyes overall and the improvement has continued to this day.

The other really important issue is managing allergens and irritants in my environment. I had to change shampoo, conditioner, moisturizing lotions, even some cleaning supplies. I had to stop all eye makeup (I am female and that hurt!), perfumes and other products with fragrances. If you look up triggers to hypersensitivities (ocular, sinus, skin) at the top of the list are fragrances. And fragrances are in what seems like everything.

I do have more classic allergies to molds and spores but pretty much most of my triggers (to ocular inflammation and sinus inflammation) are environmental irritants. Finding them and removing them from my environment has really helped.

I'm struggling to deal with my multitudinous symptoms at the moment and am looking for answers

I hope you find relief soon. I do know that it is a tough road and I hope you feel better soon.

Scout

[Scout]

ETA to post above:

I wanted to add and clarify that I was diagnosed by eye doctors for many years with "dry eyes," but after my post-LASIK problems I realized that "dry eyes" was not an accurate diagnosis per se.

I have always had low tear numbers, but adequate. However, my tear break-up time has always been severely low. 3 years after my LASIK surgery, I was tested at zero in both eyes for TBUT--the worst numbers I had ever experienced.

So I have always had an okay amount of tears, but poor break-up time. Surface inflammation has always been the problem, but no eye doctors did anything other than give me wetting drops or allergy drops.

The last time I was tested (several years ago), my TBUT was 2 and 3. That still is low but the relief was and is amazing to me.