Another depressed iatrogenic newbie (long rant)

[Evie]

Hey there. I'm at a really low point and could use some encouragement.

I had PRK about 13 weeks ago and I've been in so much pain ever since, because of dryness. On a good day, I'm putting drops in my eyes about 24 times a day during my waking hours, and then doing gel drops a few times overnight as well. Wearing moisture goggles (eye seals 4.0) at night also. On a bad day, well... yesterday, for instance, I put drops in my eyes more than 50 times. On a bad night, I wake up once every hour to put gel drops. Here's everything I've tried...

Collagen plugs - helped a little, maybe
Fish oil - no idea, continuing to take it anyway
Systane Overnight Protection Gel - severe allergic reaction
GenTeal Nighttime Ointment - mild reaction (slight redness/burning)
Steroids - Pred Gati in the immediate post-op period (two weeks) no idea if it helped or not since it was so early; Pred Forte for the Systane allergy, made me feel actually normal again; FML drops "as needed," helps sometimes (helps more with redness than pain)
Gel drops - TheraTears Nighttime Relief and Refresh Celluvisc made me feel drier after they evaporated, but CVS brand gel drops have been good
Moisture goggles at night - helps a lot, but still have never slept through the night without needing drops
Zaditor eye drops - helps a bit, I think
Zyrtec oral - helps a bit, I think (have to keep taking it anyway due to seasonal and dust allergies)
Bruder mask - made my eyes very red and didn't change anything dryness-wise
Warm washcloth compress - felt nice, didn't do anything dryness-wise


A million OTC preservative-free tears...
Blink - some relief for a minute
Refresh Plus - some relief for a minute
TheraTears - some relief for several minutes
Oasis Tears - some relief for a minute
GenTeal Moderate - some relief for a minute (feels really good for the first second or two, though)
Refresh Mega 3 - initial relief, but then burned
Refresh Optive Advanced - initial relief, then burned
Systane Ultra - some relief for a minute
Walgreens/CVS generics (carboxymethylcellulose, like TheraTears or Refresh Plus) - felt the same as brand name, but obscured my vision horribly (seemed to bead up on my eye)

Here's where I'm at right now. The first 10 weeks of my recovery were absolute misery. Weeks 11 and 12 post-op were amazing, completely out of the blue. The only thing I had changed was a week prior I started taking Heyedrate fish oil instead of Spring Valley, which I'd been taking since before surgery. I have FML drops that my surgeon instructed me to use "as needed," well, I stopped needing them. My eyes were clear and comfortable. I felt the way I had expected to feel at this point in my recovery - still dry, still needing drops about every hour, but without the dryness running (and ruining) my life anymore. Suddenly, I was sleeping better - only waking once or twice in the night to reapply gel drops. I thought I'd finally turned a corner and I was so excited that maybe I could finally put all this behind me soon. Then, last Saturday, I decided to try my new Bruder mask... just to try, even though I was feeling a bit better... I thought maybe it could help me even further. Very wrong. I followed the package instructions for heating, put it on, and six minutes later had to take it off because my eyes felt dry and painful. When I looked in the mirror, they were both red. I have felt awful ever since. Worst I've felt since the first month after my surgery, actually. Yesterday, I was non-functional, needing drops about every 10 minutes or less. Today seems slightly better, but both eyes are still a little inflamed. I used my FML drops once yesterday and again this morning, and will probably do them again tonight.

I have an appointment with my surgeon next week, at which point we will discuss permanent punctal plugs and Restasis. I also have made an appointment with a dry eye specialist the following week for a second opinion.

I am so depressed. I don't want to get out of bed most days, but I do, because I have children and no choice. I can't cry about my situation because if I do, I'll be paying for it for days after. My LASIK office is a 45 minute drive away, my surgeon is only in town twice a month, the optometrist there is an idiot, and I've burned through a bunch of my husband's vacation days due to appointments or days where I just wasn't able to function. And now to be in even worse shape than I was a week or two ago has got me really freaking out. I'm not sleeping well - both because my eyes are bothering me, and because of my anxiety about my eyes never getting better.

I don't know why the sudden backslide but I am in a right state, thinking it won't get better again. Why did I have like 12 really nice days and then suddenly I'm worse off than I was prior to that really nice 12 days? My husband says that based on my feedback, things seem to be on a really gradual uptick. He says my good streaks are better and lasting longer every time. I've started charting good days vs bad days so that I can start to see it too.

I guess I should mention I had LipiView prior to surgery and my glands are actually in pretty good shape, considering I over-wore my contacts for about 15 years.

Please tell me this might get better still. Please tell me there's something I haven't tried. Please tell me anything good aobut this situation.

[MGD1701]

Hi
Things can get better - if we dont give up.

Gland image
well, glands look prefect do NOT mean they are ok. what important is their function, if clear oil comes out when dr express them gently.

contacts for 15 yrs is very likely have inflammation/bacterial issues and to keep this under control is most important.

lid hygiene is vital. Most doctors in USA now recommend pure HOCL like Avenova.

Just did LipiView prior to LASIK is not enough - what important is if your ocular surface is healthy, which is unlikely since you wore contacts for 15 yrs.

autologous serum: perhaps this would help you.

Demodex / allergy : did dr check these?

keep learning/exploring new things and you will receive more relief, like many others. think positively.

[farmgirl]

Ditto on the autologous serum...hopefully there is someone in your area that can compound it.

[tlis29]

Hello

Welcome to the forum. This is my first post although I have regularly checked it for years. Mostly everything I have learnt about Dry Eye and what helps has come from this forum. So I hope this will help and hopefully be encouraging.

I had Lasik 5 years ago and have suffered with dry eye ever since but having said that, have things improved, yes, massively.

You are very early on in your healing process and there is much time for improvement.

Most importantly you need a dry eye specialist that you trust that can work with you to get the right treatment plan in place. It was 1 year after surgery that my Lasik clinic discharged me saying I was fine when clearly I was not. One year later I found my dry eye Doctor and after numerous tests was able to implement a treatment plan.

There are some excellent posts about what you need to ask your Eye Doctor, here are a few pointers:

Blinking - I'm a partial blinker so blinking exercises made a big difference
Quality of oil, can oil be expressed from glands, any blockages.
State of glands
Tear break up time
Schirmers - to check tear volume.
Staining for dryness
Eyelids - blepharitis

Remember you are still healing, be kind to your eyes as much as you can and look after yourself.

In the darkest moments my children kept me going and bless them for being so kind.

Now I don't use drops at all, I use Vita Pos ointment at night (I sleep through the night now), moisture chamber goggles as needed. I'm light sensitive so never leave the house without sunglasses but that's fine.

So yes you will improve but it will take time and it won't be an easy journey but try not to think months a head but take each day at a time, even each hour when the pain is bad.

Let us know how you get on at your appointments.

[Guest]

I believe when you appplied the hot compress, you caused a lot of inflammation. That is my assumption as to why you may have "slid back" as you said. I'm not a doctor so all I can offer you is my own experience. A low dose steroid like alrex or lotemax, always gets me feeling better. I see that steroids right after treatment had you feeling normal. I assume you're battling cyclic inflammation and again, that compress sent you out of control.

Check with you doctor but describe in detail what's going on...possibly go see another dr. It took me about 6 doctors before I started getting first rate medical treatment.

I know this is ruining your life at the moment, but if you stick with it and do everything possible to heal well...diet, supplements, prescription drugs, serum tears, etc. you will give yourself the greatest opppurtunity for a better outcome. I've been where you are, the yo yo of thinking things may be alright and then boom, huge set back. But just like everyone else said, you can get better. Wish you the best!