Help solve my eye issue (dry eye? MGD?)

[thedarktitan]

Hello all long time lurker and appreciate this forum.

A little info on me: 30 year old male. Soft monthly contact wearer for 15 years.

So my main issues started in spring of 2017, however my eyes have always seemed to water easy especially when laughing. Last spring my contacts seems to become more dryer than normal, but I could still wear them. I think I actually developed GPC then. I battled through the spring not thinking much of it or having eye issues. Fast forward to June. My eyelids seemed to burn a lot. I called an eye dr. and they confirmed that I had GPC and wanted me out of contacts for two weeks. Two weeks went by and gpc cleared up, however I was unable to wear contact comfortably without my eyes starting to water. I also noticed that in the morning my eyes are and have been since June red.

I have since all of this went to multiple eye doctors just trying to get some answers and possibly get back into contacts. All of the doctors say that my eyes are heathy and that they may be slightly dry. I even had one doctor say that my eyes were the healthiest they’ve seen all day!
I personally think that i have MGD.

Current issues:
-red water eyes in the morning
-eyes water when laughing
-unable to wear any contacts - tried multiple brands
-watery eyes at night before bed. Water when laying down.
-my actual eyes don’t hurt or anything, and some days are better than others.

Things that I have tried:
-every possible PF eye drop- does not work
-xiidra - no effect
-lotemax - no effect
-warm compress mask - works the best. I can do this in the morning and my eyes won’t bother me all day until around bed time and my eyelids will start to slightly burn and water

[PhoenixEyes]

Contact lens wise ones with low to average water content and high oxygen permeability (Dk/t value) can reduce risk of dry eye I think, as they allow the eye to breathe and don't suck up moisture as much. You could also try daily contacts instead of monthlies to reduce risk of bacteria etc. I hear some recommend brands like Coopervision Dailies Total 1 or Acuvue Moist in that respect.

If they don't work out then you may consider scleral contact lenses which have a slight gap over the cornea you fill with artificial tears. They're rigid gas permeable lenses that can be used specifically to help alleviate dry eye. There are various organizations and clinics that have a lot of experience in fitting them such as LaserFit, Boston for Sight etc.

You could try doing the warm compress twice a day, once in the morning and once at night, that's what I was advised to do by an ophthalmologist. If that isn't enough to help alleviate morning redness then you can also try a thicker preservative free drop (e.g. Refresh Celluvisc, Thealoz Duo Gel, carbomer single dose vials) or ointment (e.g. VitA-Pos, LacriLube / Xailin Night) at night.

Hope you find relief soon.

[thedarktitan]

Thanks for the response.

-I’ve tried most all contacts that are within my script, none seem to work.
-I would be willing to try scleral contact lenses if were available anywhere close to me. (Louisiana)
-warm compresses seem to be the only thing that alleviates the symptoms.
-eye drops seems to irritate my eyes. It seems anything I put in my eyes tends to irritate them. I’ve tried them all. The latest I’ve tried have been refresh advanced.

I would just love to figure out what the issue actually is. Again I’m fine during the day once I do my morning warm compress. I just can’t wear contacts. Of course most of the eye doctors start trying to push lasik..... ain’t no way I’m doing that unless I figure out what’s going on.

[PhoenixEyes]

You could get your meibomian glands expressed by an ophthalmologist to check their function and confirm whether MGD is indeed a factor, could also look into getting checked for blepharitis. There was an old study to suggest treating MGD and blepharitis can lead to successful contact lens wear and reduction in GPC for some people.

https://www.researchgate.net/publica...on_blepharitis

Certainly try increasing warm compresses to twice daily since even once is having success, before bed for example.

Beyond dry warm compresses for MGD and blepharitis some other options for treatment are:

- Moist heat therapy: Bruder mask, Optase Moist Mask, facial steamer, Blephasteam

- Eyelid wipes: Blephadex, Cliradex, Ocusoft Plus, Optase Tea Tree

- Pure Hypochlorous sprays: Heyedrate Lid Lash Cleanser, Avenova, Hypochlor, Briotech Skin Spray, Natrasan First Aid, Aquaint Sanitising Water

- Cleansing gels: iLast Hydraclean, Blephagel

- Antioxidants: Omega supplements, Citrus green tea, Lutein / Zeaxanthin / Astaxanthin via diet or supplements

- Lipiflow, Miboflow, Intense Pulse Light (IPL), gland probing

I'm not in America but there's a lot of Boston for Sight clinics so could check if one is near you for scleral lenses. Or LaserFit is in the next state over in Texas: https://laserfitlens.com

[thedarktitan]

Thanks Phoenixeyes. It’s nice to speak with someone that somewhat understands..

-I’ve tried lid scrubs and they seem to irritate my eyes.
-I’m interested in Lipiflow, Miboflow, Intense Pulse Light (IPL), gland probing, but it doesn’t seem like anyone around me does that. I think that probing would probably solve my issue.
-My next course of action is to try TheraTears omega 3 supplement.

-how could I tell if it’s MGD or Blephoritis

[PhoenixEyes]

An ophthalmologist should be able to diagnose MGD vs Blepharitis. Some people have both though.

[thedarktitan]

The last eye doctor I went to say that the oil looked and was flowing good.....

[Hokucat]

Hi darktitan. I think PhoenixEyes pretty much said it all. I can totally understand you want to solve the underlying problem, that is wise.

I know you mentioned you think you need probing, but given warm compresses work for you, and assuming the last doctor was correct that your oil looked and was flowing well, you might not need probing at this time. Probing is quite invasive, and is helpful especially if your glands are blocked, but does not sound like yours are. Don't get me wrong, it has helped people like me who had stubborn blockage in almost all glands, plus I also had scar tissue which only probing could unblock.

It sounds like you might need to improve the quality of your oil, and possibly eliminate bacteria though. You might try diet changes and/or the supplements and antioxidants PhoenixEyes mentioned above, as well as the wipes and sprays. For me, after my glands were unblocked with probing, I too had to improve my oil quality. Drinking fresh lemon juice in green tea 2x daily was a major turnaround for me. For you it might be some other diet change or supplement your body needs.

Sclerals do not solve the root cause, but can greatly relieve symptoms, if you are able to tolerate the lenses...not everyone can wear them. I wear my Boston PROSE scleral lenses 12+ hours a day, and it helps a lot, and have been very happy with the experience of my Boston doctor getting the fit just right, which is important. Here are some other resources to help you find the closest reputable scleral fitter near you, there are different brands:

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

http://www.bostonsight.org/PROSE/PRO.../Find-a-Clinic

http://www.bostonsightscleral.org/

http://www.sclerallens.org/scleral-fitters

https://www.eyeprintpro.com/patient/

Also, here's a private clinic in Louisiana that came up for sclerals when googled, but don't think they are associated with any of the above resource lists:

https://www.shenandoaheyeclinic.com/...ally-big-news/

Hope you resolve your situation soon. And if you have eye issues now, especially possibly dry eyes, you are right to stay away from LASIK!

[thedarktitan]

Hokucat,

Thanks for the detailed response. Its nice to know that there are other people out there that understand.

-Thanks for the enlightening on probing. However the same doctor that said my oil was flowing good recommended that I should have lasik since contacts were not working out. Not even considering lasik until i exhaust all contact options and if ever able to resolve this issue. Glasses forever will be hard on my career.
-Yes, maybe that is the issue with the quality of oil. Today will start my second day on theratears omega 3, I know its a long shot that it will work, but a lot of reviews back it up. So I'm hopeful. My diet could also be better! It is crap!!
-Thanks for finding that sclerals place in Louisiana. I googled it the other day and couldn't find anywhere. The place that i called was the place in Texas mentioned above and the price was a little steep ($4500) plus a five day stay.

-An example of my eyes - This morning i woke up and they were extremely watery. I also had more than normal crusty stuff, but not so much that I couldn't open my eyes or anything. They were also red/irritated. My eyes don't hurt, they only sting sometimes, like they are tired. So I used my warm compress mask and after a few minutes they seemed back to normal. When i take the mask off, my eyes are normally blurry for a little, which I know that is normal from the oils and water.

-I think my issues have came from overusing monthly contacts for years, not switching out the contacts on regular intervals (using one pair for months) and also not switching out solution every night. I remember over a year ago I had a couple of times where I would have this sticky discharge. I would just battle through it and then it would go away...I am an advocate for daily contacts to all the people I know, none of the people really hear me though.. I don't know if this will mean anything or not, but i could be having some underlying gallbladder issues.

[Hokucat]

You're welcome, darktitan. I just wanted to add that you will have the best chance of success being able to wear sclerals if you are fitted by a practitioner who has a lot of experience and expertise in that area. Dr. Gemoules in Texas with his LaserFit lenses and Boston PROSE are two of the top fitters. EyePrintPro is supposed to be up there too. I gave you the link to the clinic in Louisiana because from quick review of the other links above, it didn't look like there were any resources in your state, and you mentioned you wanted someplace near by. But do not know how experienced they are at fitting sclerals.

Do you have good medical insurance? If so, the Boston PROSE clinics will check your insurance for you, I think before you even have the consult, to see how much is covered, assuming the lenses are considered a medical necessity for you. Mines were almost completely covered, I think I just paid a few hundred dollars.