Hi new here.. a few questions

[ishank_b]

Hello,

I am Ishank from India. How is everybody doing here?

I use computers a lot, I sit like 10 hours (or more) for almost 10 years. I have suffered eye strain and dry eyes two times in my life- back in 2011 and 2013 but those got resolved after a couple of weeks. I think it was caused by lack of sleep and computer use.

This time I am not sure what is going on. I apologize if these series of events baffle you.

---------------------
July-Aug 2018

Well, this started about two months ago. I was staring mobile phone late night ( around 2 AM) in the darkroom) and next day I had this eye strain- my symptoms were- pain on eyes, tired eyes, sometimes pain behind eyeballs. I went to an eye clinic, they did all checkup, Eyesight 6/6- no issue. They gave me some drops- Carboxymethyl Cellulose 0.5%. (Eco Tears). They prescribed me a zero power ( I think) computer glass- anti-reflective lens. They asked me to wear it every day. I did not wear it though- :| I vaguely recall but it kinda worked that time.

One thing to note here- If I refrain from the computer use for a day. It felt better.
The important thing is to notice my symptoms are not consistent. I think they waxed and waned during this time.
-----------------------
Last Week Aug 2018 (Travel)
Then I had to travel to a different city for a week (2nd week of August). And my routine was all messed up for a week or so. I couldn’t get a wink of sleep for two nights (1 day and last day of my trip)during those 7 days trip. I did have the eye drops with me but they were not working at that time. My symptoms were tired eyes, eye pain, headache temple sometimes pain behind eyeballs.

--------------------------------------------

As I returned back to my city (26 August), I went to the clinic again. They did the checkup again. They changed the eye drops brand (a little expensive) but the ingredient was same - Carboxymethyl Cellulose 0.5%c (Zyqua)

The important thing is to notice my symptoms are not consistent. I think they waxed and waned during this time.
-----------------------
Sep 2018

I used the eye drops for a week and then I changed the doctor. Went to a new doctor showed her the prescription and my history. She checked the eyes and asked me about my lifestyles and sleep routine. She told me my eyes look tired. So told me to continue the Carboxymethyl Cellulose 0.5%c (Zyqua) 4 times a day and added a new drop for tired eyes- Ns Aid 0.1% Eye Drop (diclofenac sodium ophthalmic solution). She told me to put these drops 10 minutes after Zyqua- 4 times a day for 10 days and then to report her back. I think this combination worked for 9 days. Then I forgot to put the drops and played the online games for a couple of hours on my PC. And it gave me minor eye strain and headache.

I went back to her and she asked me to continue both eye drops for 7 days and use the computer glasses. (12th sep 2018) I

But I don't have eye strain or a headache but I had this new symptom- dry eyes. I used drops for 6 days and did not use the drop purposely on the 7th day. I think its new I don't recall. I feel my eyes are dry almost all day. I mean I feel it literally. I also feel dry eyes when I wake up in the morning- this is a new symptom.
--------------
19/09/2018
I went back to the doctor with new symptoms she told me to discontinue Ns Aid 0.1% Eye Drop (diclofenac sodium ophthalmic solution). And told me to use computer glasses and use Carboxymethyl Cellulose 1% (Lubrex - DS) for 30 days.

I asked her if I need some kind of eye gel for night time to prevent dryness. She said she did not think it was necessary for my condition at this time. She said I have perfect eyesight. But I would need to use eye drops. The eye drops are safe to use. And I need to change lifestyle.

------------

My questions:

1) My symptoms- Dry eyes in the morning- I feel it. When I pour water into my eyes I feel like gritty sensation- I don't think I had it in July-Aug 2018. Mild dry eyes almost entire day. Riding a bike may make it worse for an hour or so. No headache. No eye strain. But just dry eye feeling. My major concern is the dry eyes feeling when I wake up in the morning.

2) I was reading some posts on this forum. I came to know about this harmful preservative- benzalkonium chloride solution. I checked the Ns Aid 0.1% Eye Drop which I used for 2 weeks or maybe 20 days. Do you think this has induced this dry eyes feeling? If yes, how long this feeling going to last?

3) I also read this forum and come to know that we should use preservative free eye drops. The current eye drops that doctor has prescribed me is Carboxymethyl Cellulose 1% (Lubrex - DS) it has the Oxychloro complex as a preservative. Should I be concern about it?

4) Does using artificial lubricants reduce the natural abilities of our eye glands to produce tears?

5) I have been cured/treated this condition two times in the past. But this time it has lingered quite a long. Does it mean this dry eye issue going to be with me for the entire lifetime?

6) Is there eye exercises that will help me?

7) Any dietary changes?

8) I also came to know about MGD thing on this form? Do I look like a sufferer of MGD? How do I know? Any way to check it at home?

9) Does fish oil help in my condition? I just bought a pack of fish oil.

I know I am acting weird but this dry eye feeling is PIA, especially for a person has a bit of OCD in his behavior .

I really appreciate your insights. Waiting for your my questions to be answered.


Thanks,
Ishank

[hopeful_hiker]

Hello! Welcome to the forum.

I don’t know enough about “okay” preservatives so I stick to preservative-free stuff. I would rather not stress my eyes any further.

8) Your docs can tell if you have MGD. In my case they pressed on the eyelids to see if the oil comes out and to observe its quality. Oil gland loss can be seen with things like Lipiview or Keratograph. These devices take photos of the glands. Clinics that have Lipiflow are likely to have such cameras.

This is is an important question. What is causing your discomfort? You may need to go through several docs until you get a confirmation.

[Milo007]

Hello,

I am Ishank from India. How is everybody doing here?

I use computers a lot, I sit like 10 hours (or more) for almost 10 years. I have suffered eye strain and dry eyes two times in my life- back in 2011 and 2013 but those got resolved after a couple of weeks. I think it was caused by lack of sleep and computer use.

This time I am not sure what is going on. I apologize if these series of events baffle you.

---------------------
July-Aug 2018

Well, this started about two months ago. I was staring mobile phone late night ( around 2 AM) in the darkroom) and next day I had this eye strain- my symptoms were- pain on eyes, tired eyes, sometimes pain behind eyeballs. I went to an eye clinic, they did all checkup, Eyesight 6/6- no issue. They gave me some drops- Carboxymethyl Cellulose 0.5%. (Eco Tears). They prescribed me a zero power ( I think) computer glass- anti-reflective lens. They asked me to wear it every day. I did not wear it though- :| I vaguely recall but it kinda worked that time.

One thing to note here- If I refrain from the computer use for a day. It felt better.
The important thing is to notice my symptoms are not consistent. I think they waxed and waned during this time.
-----------------------
Last Week Aug 2018 (Travel)
Then I had to travel to a different city for a week (2nd week of August). And my routine was all messed up for a week or so. I couldn’t get a wink of sleep for two nights (1 day and last day of my trip)during those 7 days trip. I did have the eye drops with me but they were not working at that time. My symptoms were tired eyes, eye pain, headache temple sometimes pain behind eyeballs.

--------------------------------------------

As I returned back to my city (26 August), I went to the clinic again. They did the checkup again. They changed the eye drops brand (a little expensive) but the ingredient was same - Carboxymethyl Cellulose 0.5%c (Zyqua)

The important thing is to notice my symptoms are not consistent. I think they waxed and waned during this time.
-----------------------
Sep 2018

I used the eye drops for a week and then I changed the doctor. Went to a new doctor showed her the prescription and my history. She checked the eyes and asked me about my lifestyles and sleep routine. She told me my eyes look tired. So told me to continue the Carboxymethyl Cellulose 0.5%c (Zyqua) 4 times a day and added a new drop for tired eyes- Ns Aid 0.1% Eye Drop (diclofenac sodium ophthalmic solution). She told me to put these drops 10 minutes after Zyqua- 4 times a day for 10 days and then to report her back. I think this combination worked for 9 days. Then I forgot to put the drops and played the online games for a couple of hours on my PC. And it gave me minor eye strain and headache.

I went back to her and she asked me to continue both eye drops for 7 days and use the computer glasses. (12th sep 2018) I

But I don't have eye strain or a headache but I had this new symptom- dry eyes. I used drops for 6 days and did not use the drop purposely on the 7th day. I think its new I don't recall. I feel my eyes are dry almost all day. I mean I feel it literally. I also feel dry eyes when I wake up in the morning- this is a new symptom.
--------------
19/09/2018
I went back to the doctor with new symptoms she told me to discontinue Ns Aid 0.1% Eye Drop (diclofenac sodium ophthalmic solution). And told me to use computer glasses and use Carboxymethyl Cellulose 1% (Lubrex - DS) for 30 days.

I asked her if I need some kind of eye gel for night time to prevent dryness. She said she did not think it was necessary for my condition at this time. She said I have perfect eyesight. But I would need to use eye drops. The eye drops are safe to use. And I need to change lifestyle.

------------

My questions:

1) My symptoms- Dry eyes in the morning- I feel it. When I pour water into my eyes I feel like gritty sensation- I don't think I had it in July-Aug 2018. Mild dry eyes almost entire day. Riding a bike may make it worse for an hour or so. No headache. No eye strain. But just dry eye feeling. My major concern is the dry eyes feeling when I wake up in the morning.

2) I was reading some posts on this forum. I came to know about this harmful preservative- benzalkonium chloride solution. I checked the Ns Aid 0.1% Eye Drop which I used for 2 weeks or maybe 20 days. Do you think this has induced this dry eyes feeling? If yes, how long this feeling going to last?

3) I also read this forum and come to know that we should use preservative free eye drops. The current eye drops that doctor has prescribed me is Carboxymethyl Cellulose 1% (Lubrex - DS) it has the Oxychloro complex as a preservative. Should I be concern about it?

4) Does using artificial lubricants reduce the natural abilities of our eye glands to produce tears?

5) I have been cured/treated this condition two times in the past. But this time it has lingered quite a long. Does it mean this dry eye issue going to be with me for the entire lifetime?

6) Is there eye exercises that will help me?

7) Any dietary changes?

8) I also came to know about MGD thing on this form? Do I look like a sufferer of MGD? How do I know? Any way to check it at home?

9) Does fish oil help in my condition? I just bought a pack of fish oil.

I know I am acting weird but this dry eye feeling is PIA, especially for a person has a bit of OCD in his behavior .

I really appreciate your insights. Waiting for your my questions to be answered.


Thanks,
Ishank

Answering your questions in the order you have asked :

1. You most probably have MGD owing to prolonged digital screen abuse.

2. BAK is the worst of preservatives and yes it's quite possible it has worsened your condition but it's not the cause of developing MGD. Avoid preservative free drops for daily long term use , I mean to include all preservatives. A good preservative free lubricating eye drop available in India is Eubri eye drops. But it's costly.

3. Oxychloro complex is relatively less cytotoxic compared to many other preservatives but it's cytotoxic. So over a period of exposure it will harm your ocular health. Better switch to Eubri eye drops.

4. Yes using artificial lubricants too much reduces tear production from the lacrimal glands because the feedback loop is disturbed due to unnatural substitution of the essential aqueous layer of the tear film. In your case artificial tears are not a solution at all. Better visit a good eye speciality that handles dry eye as a sub speciality. Using artificial eye lubricants too often also washes away the mucin layer and disrupts tear film stabilization.

5. You didn't cure your condition in the past but they were mere warnings of a compromised meibomian gland functioning. Now, your gland health is critical and serious enough to present symptoms. You might have to live with MGD the rest of your life depending on the current condition of your glands. My advice - Rush to a dry eye speciality as soon as possible and begin thorough investigation and advanced protocols of treatment.

6. Eye exercises won't help in your case.

7. You may include omega 3 rich foods or supplements. Avoid smoking at all costs.

8. You most probably have MGD. To know if you have MGD just go to the bathroom and flush the floor with water and stay for there 5 minutes. See if you find it more comfortable to keep your eyes open in there. If yes you probably have MGD with or without aqueous deficiency. Alternatively, you can check for blocked gland openings in front of mirror with a close view of your eyelid margins. But it's always advisable to ask your ophthalmologist to check your glands under a slit lamp microscope for visible blockage. Meibography is strongly advised.

9. Fish oil has no dramatic effects on MGD. It may slightly improve your condition only if the key reason for MGD is addressed. You MUST clear gland blockage anyhow. You can try a protocol for clearing gland blockage - 100mg doxycycline tablets twice for 1 week followed by once for the next three weeks along with azithromycin 1% eye ointment for a month. But I strongly advise to visit Narayana Nethralaya for a comprehensive investigation and treatment.


I used to have OCD but it's not about obsession with your condition because your condition could worsen if you don't act pro-actively right now. I would advice to consider your eye condition as a priority at this stage before it worsens due to negligence.

[ishank_b]

Thank you, I am going to make an appointment in the next two days. Going to one of the best doctors.


"You most probably have MGD. To know if you have MGD just go to the bathroom and flush the floor with water and stay for there 5 minutes. See if you find it more comfortable to keep your eyes open in there."

Flush the floor with water? "if you find it more comfortable to keep your eyes open in there"

How does it help in diagnosing my problem? I don't get it. Please elaborate.

[Milo007]

Thank you, I am going to make an appointment in the next two days. Going to one of the best doctors.


"You most probably have MGD. To know if you have MGD just go to the bathroom and flush the floor with water and stay for there 5 minutes. See if you find it more comfortable to keep your eyes open in there."

Flush the floor with water? "if you find it more comfortable to keep your eyes open in there"

How does it help in diagnosing my problem? I don't get it. Please elaborate.

I meant to wet the bathroom floor with water to raise local humidity. See if you feel more comfortable in high humidity conditions. Eyes with MGD will get immediate relief in high humidity conditions.

[ishank_b]

Oh, I got it.

Hard to say.

Its rainy weather outside since yesterday. I don't feel bad today. But after computer use, I feel the discomfort in my eyes. Sometimes I don't- for example, I am not feeling discomfort in my eyes while writing replies on this forum. But I was having some discomfort a couple of hours ago. It's raining outside since morning.

You see I have been getting eye issues in July, Aug, and Sep, which is a rainy season so humidity is over 85%.


----
Although I did one test a couple of times. I pulled my upper lids for a few seconds and gaze into a mirror to see if my eyes are making tears in case of irritation. It does... My lower eyelids are making tears when I gaze two long while pulling the upper eyelids in an upward direction.

[ishank_b]

BAK is the worst of preservatives and yes it's quite possible it has worsened your condition but it's not the cause of developing MGD. Avoid preservative free drops for daily long term use , I mean to include all preservatives. A good preservative free lubricating eye drop available in India is Eubri eye drops. But it's costly.


I used for 2 weeks or maybe 20 days. Is this considered a long or short term use?

[Milo007]

BAK is the worst of preservatives and yes it's quite possible it has worsened your condition but it's not the cause of developing MGD. Avoid preservative free drops for daily long term use , I mean to include all preservatives. A good preservative free lubricating eye drop available in India is Eubri eye drops. But it's costly.


I used for 2 weeks or maybe 20 days. Is this considered a long or short term use?

It's a short term use don't worry about that.

[Milo007]

Oh, I got it.

Hard to say.

Its rainy weather outside since yesterday. I don't feel bad today. But after computer use, I feel the discomfort in my eyes. Sometimes I don't- for example, I am not feeling discomfort in my eyes while writing replies on this forum. But I was having some discomfort a couple of hours ago. It's raining outside since morning.

You see I have been getting eye issues in July, Aug, and Sep, which is a rainy season so humidity is over 85%.


----
Although I did one test a couple of times. I pulled my upper lids for a few seconds and gaze into a mirror to see if my eyes are making tears in case of irritation. It does... My lower eyelids are making tears when I gaze two long while pulling the upper eyelids in an upward direction.

Don't pull your lids or irritate them. You could end up damaging your eyelids or glands or possibly catch an infection. Eyelids are delicate things don't mess with them just because you are impatient. Go to a doctor and let him or her investigate.