New UK member post LASIK dry.

[MGD1701]

lipid layer
well, one of my eyes now almost 80, nearly double from previously and my eyes have been fit (& no inflammation presents, I was told) so I wondered what discomforts you might encounter since yours is 80.

I do not have itchy, red, buring eyes but lid cleanser with pure HOCL, helped me free from watery and discharge. Now I am 200% sure effective/safe lid cleanser is very important and NOT all cleansers are the same. Did dr recommend you any lid cleanser?

night: maybe thick gel would help?

Rapid TUBT
Good to check if you have CCH or Goblet Cell/Mucin deficiency issues. CCH is very common (amoung MGD suffers) but under diagnosised.

Hope you find more relief soon.

[mbperso]

lipid layer
well, one of my eyes now almost 80, nearly double from previously .

Great news to know you've improved your LLT until almost 80 ! and good that you've got image of your glands since your second Lipiview.
From what I read LLT >70 is normal. My LLT before Lipiflow was 47 and I didn't have a second Lipiview yet, to compare.

[mbperso]

quattroboy ,

LLT 80 is pretty good, and glands are not blocked so not sure Lipiflow will help a lot
Low TBUT => did you do a schirmer test ?

[quattroboy]

hi mbperso

You're correct Lipiflow didn't really help, with TBUT stuck at around 3 seconds in my left eye, slightly better in my right around 6 seconds.

I have lost a lot of my glands, the cause seems to be partial blinking and not blocked glands or poor quality oil.

No, the consultant last week didn't do a schirmer test but I am seeing him again on the 17th July. I will ask. But I think it was fairly clear to him that there are reduced basal tears. Resulting from the LASIK.

I thought low TBUT was associated with evaporation dry eye and not low tear production? The main culprit of low TBUT being a poor lipid layer?

I've also read mucin plays an important part in tear break up.

He felt there was general inflammation in my eye, hence the steroids and Ikervis (Restasis isn't licensed in the UK).

[mbperso]

hi quattroboy ,

Sorry you've lost half of glands, this is curious because the others glands were not blocked ! The good news is your normal 80 LLT.
Indeed that may mean that the root cause is only partial blinking. Did you lost only nasal glands (the nose side) or are there some lost glands elsewhere ?
I lost nasal glands too and I had 100% of partial blinks.

Tears
Yes usually the cause is either glands or tears, but it is always good to confirm or not diagnosis with tests.
Phenol Red Thread test (PRP) is less invasive et faster than Schirmer test. (box of 50 =72€)
How to know if mucin could be a cause ?

[quattroboy]

Yes mbperso you are correct my lost glands are near my nose. This is the result of the partial blinking, I'm not fully closing my lids near my nose, so no pressure on the lids there to release the oils, hence gland loss. It also left the inner corners of my eye exposed, which is where the most staining can be found.

This also explains why Lippiflow hasn't helped.

Mucin is also important in the tear film, I think it's produced by the goblet cells in the eye. However, the goblet cells tend to die in dry eye because of effects of inflammation (T-cells etc) and/or lack of nourishment from basal tears. No expert just reading around the net.

I've read Cyclosporine based products (Ikervis and Restasis) can restore goblet cells with prolonged use. Again not sure if this is true.

Maybe someone can correct me if I've misunderstood stuff.

And finally, LASIK has really screwed everything up! I wasn't screened properly for existing dry eye before going ahead with the procedure.

[MGD1701]

Hi,
Indeed rapid TBUT (& conjunctival scarring, Vit. A deficiency) have links to goblet cell/mucin deficiency.

Treatment options
Xiidra or Restasis (so quattroboy is right about Restasis - these two are to tackle inflammation)
Vit A. ointment
Moisture chamber goggle, or
scleral lenses

+ Amniotic Membrane (Prokera)
as requested by member, quattroboy,
'supposed to help restore and heal the eye surface'.

These info is based on what I have learnt from US opinion leaders - can not remember who mentioned it though.

Well, I have learnt that GLA (omega 6) can help with this issue - to be exact, can increase all layers production. My eyes do feel much better after adding it with flaxseed oil. Study shows such combination works more effectively (than alone).

[quattroboy]

Hi, MGD1701 Could you add amniotic membrane (Prokera) to the list of treatment options? Supposed to help restore and heal the eye surface.

Which type of flaxseed oil are you using? I'm currently taking Flaxseed cold pressed capsules but not sure if there actually helping, most of these supplements don't really have nearly enough concentration in them. Usually in the very low mg.

I'm also taking high dose Omega 3 and eating a daily portion of oily fish.

[MGD1701]

Flaxseed - oil, bio, cold pressed. If you have taken for 2-3 months and still no improvement - good to check the volume. If you have never taken omega or fish oil, you need higher amount.

Not all supplements are the same - the quality one is expensive as they remove heavy metals etc. Most US opinion leaders recommend HydroEye (with GLA & different Vit.). Maybe you could get their contents & % as a guidline. Combine with Vit. C, E, seems work more effectively.