Sudden dry eye onset + weird symptoms, 29 years old (F)

[farmgirl]

To adequately treat dry eye it is helpful to know what is causing it. If you have Sjogrens you will definitely be aqueous deficient and probably will also have MGD. If you are aqueous deficient then the cyclosporin drugs are more likely to help than if you just have MGD/blepharitis. Plugs and or cautery for sure will help as quite likely will moisture chamber glasses. For some people Evoxac or Pilocarpine can be helpful as well.

Sjogren's can affect more than the eyes so knowing you have it can be helpful because you know what to watch for in other areas.

By the way hannamaywills I don't recommend cautery for all 4 puncta as a lot can change and over tearing can be a huge problem.

[Frustrated34]

What is a bad osmolarity score ? Mine was 307 one eye !

[farmgirl]

HI Frustrated:

Dry eye is a disease. Dry eye is a multifactorial disease of the tears and ocular surface that results in symptoms of discomfort, visual disturbance, and tear film instability with potential damage to the ocular surface. It is accompanied by increased osmolarity of the tear film and inflammation of the ocular surface. Abnormal Osmolarity is defined by: An elevated reading, >300 mOsm/L, indicating loss of homeostasis. OR, When the inter-eye difference is >8 mOsm/L, indicating instability of the tear film. A symptomatic patient with normal tear osmolarity may not have dry eye.

In basic terms, tear osmolarity can be defined as the saltiness of the tears. According to Tearlab.com, “as osmolarity in your tears increases ocular surface cells become damaged,” leading to an increased likelihood of developing dry eye disease.


Understanding the Osmolarity Test Result

Abnormal tear osmolarity is a failure of homeostatic osmolarity regulation, a key feature of dry eye disease (DED). When left unchecked, hyperosmolar tears in early stage DED will lead to damage of the cornea and conjunctiva evident in later stage disease. The higher the osmolarity, the more severe the dry eye.

TearLab recently conducted a clinical trial that recruited over 300 patients in which over 600 eyes were evaluated. Using patients selected from the general patient population, osmolarity was found to have 88% specificity, 75% sensitivity in mild/moderate disease and 95% sensitivity in severe disease at a diagnostic cutoff of 308 mOsms/L. Osmolarity values above 308 mOsms/L are therefore indicative of dry eye disease.

These data was presented at the American Academy of Ophthalmology in November of 2009.

While there are several suggested cut-off values in the literature, historical studies have been based either on trials with a small sample size or populations weighted toward more severe disease (Gilbard and Farris, Tomlinson et. al.). These studies identify a diagnostic cutoff of 316 mOsms/L for more moderate/severe patients. While this cutoff is still relevant using the TearLab, i.e., 316 mOsms/L is a good cutoff for more moderate/severe patients, TearLab found that 308 mOsms/L represented a superior value for delineating the earlier, more mild forms of the disease in patients selected from the general population.

I would suggest that based on this information with a score of 307 you fall just under the 308 which is diagnosic of DED. Some reports state that anything over 300 is indicative of dry eye so I would say that you are somewhere in the mild range if you have other symptoms.

My dry eye is considered moderate and for the record, at my first testing prior to my IPL treatment, mine was 325 in one eye and 326 in the other, I am hopeful that will improve on subsequent testing.

[Frustrated34]

Hi farmgirl

wow thanks so much for the thorough explanation regarding osmolarity! It makes me feel better to be in a mild range possibly although I constantly have troubles and can’t wear contacts anymore!

how are you finding IPL? Do you have constant inflammation ?

[Guest]

Has anyone tried Acupuncture or Acupressure for dry eyes?