Newly diagnosed and worried :(

[KittyCat]

Hello everyone, I'm 33 and living in England and after a month of a weird dry feeling in my left eye, I've been diagnosed with evaporative dry eye.

I have so many questions (naturally) because this is all strange and new and confusing, but I suppose my main question is; am I destined to just get worse and worse?

I watched a video by Dr Korb yesterday (I'm a very anxious person and I obsessively Google things to try to get as much info as I can), and he talks about MGD being the leading cause of dry eye and that it's progressive. This terrifies me!

My optometrist hasn't told me what's caused this, and said it's rather unusual as it's only one eye being affected. All he's told me to do is do warm compresses, lid massage and lid scrubs. He also said, and I quote, "It's nothing to worry about, but it is a nuisance." He didn't seem worried at all.

I've been doing the compresses/lid treatments for 3 weeks now and my use of OTC eye drops (HycoSan Extra) has probably reduced from 20 times per day at the beginning to 10 times per day this week. Surely this is still too much though? He told me to come back in 2 months if it hasn't got better or has got worse.

I suppose what I'm asking is, did everyone start with mild/moderate dry eye and it's just got worse for severe patients? Should this be being looked at as something to urgently treat rather than just "seeing what happens in 2 months"? I've been reading so much on this forum and you all seem so wise and empathetic, so I thought I'd ask for any advice and support. I'm so so scared.

[Meibum Ian]

Hi,

Try. not to be too scared. This forum naturally attracts those worst affected by the condition.

That said I think it is good to get the best care early on, by someone with good specialist knowledge. Where in England are you (Bristol here)?

[KittyCat]

Thanks Ian. I'm in Birmingham. I've just tried to contact the Dry Eye clinic at Aston Uni, but of course due to Covid they're not running. Do you think I should try to see someone privately as soon as I can? My GP has said he won't refer me anywhere until I've tried the warm compresses/lid massage for at least 6 weeks.

[Meibum Ian]

The Aston clinic looks like it has good diagnostics and prices. A new one for me so thanks for sharing.

Other options nearish you include
BBR optometry (Hereford)
TKS optometrists (Northampton)
Prof. Harminder Dua (Nottingham)
Myer Yodaiken (Manchester)
David O'Brart (London)

Of these I've only visited BBR & David O'Brart, who I found to be good.

In my case I think earlier / more intervention might have helped. However I am now doing better - just a longer recovery time I think.

[KittyCat]

That's really helpful, thank you! When you say you're better now, how do you mean? Did you have to take medication to get it under control? Sorry to be asking such basic questions, but my optometrist gave me no information whatsoever about this! Did your condition start out as mild or moderate and progressed?

[KittyCat]

Hi Meibum Ian just a small note to say thank you for the recommendations! I've just spoken to BBR and the receptionist was so lovely and helpful! She said I'm doing the right thing being proactive in having a full diagnosis as quickly as possible. I'll let you know what happens after my appointment. Thank you again!

Cat

[Meibum Ian]

Hi Meibum Ian just a small note to say thank you for the recommendations! I've just spoken to BBR and the receptionist was so lovely and helpful! She said I'm doing the right thing being proactive in having a full diagnosis as quickly as possible. I'll let you know what happens after my appointment. Thank you again!

Cat

No problem.

I've found my visits there to be positive. Let us know how you get on.

To answer your earlier question, I have settled on a couple of topical medications having tried lots of different things over time.

[Hokucat]

Hi Cat. I have several good friends who have had dry eyes as long as I have (10+ years now!), and none of them have developed into debilitating conditions like mines did. But it’s good you are being proactive because in almost any condition that can help in the long run. Am glad you are going to a specialist to get a more complete diagnosis.

You mentioned you are doing warm compresses and watch Dr. Korb’s videos. I’ve found in between and after doing my two 10 minute sets of warm compresses that if I do blinking exercises like Dr. Korb’s, it help give a little more moisture as part of the warm compress process. I think probably because since the meibum is more liquified by the heat, pressing the eyelids together expresses more than not doing these purposeful blinks. I have do two sets of 10 minute warm compresses because that makes it warm enough to liquify my meibum. Probably a good idea to do blinking exercises throughout the day, assuming your meibomian glands are getting clogged (if warm compresses seem to help you).

https://www.skyvisioncenters.com/201...exercises-app/

My condition was very severe for several years, but I’ve been able to manage it with diet and some treatments, so even if your condition gets worse that does not mean you can’t get better...here’s my journey I documented for Rebecca’s Dry Eye Stories in case you are interested, plus there’s many other stories there where people have been able to get better or manage their condition:

https://www.dryeyestories.com/new-bl...ous-deficiency

Hope your appointment goes well!

[PhoenixEyes]

Hi Kitty, I'm in Birmingham, though I was fast tracked through the NHS system due to the sudden severity of my condition, so I'm afraid I don't have much experience with private optometrists etc. I do think Aston University would be good to try though, I reached out to them in the past as they are one of the few places in UK with a Keratograph which is good for checking the condition of the meibomian glands. Dr. Wolffsohn who is based there was very helpful. I started off under the care of the ophthalmology clinic at Queen Elizabeth Hospital (Dr. Kolli), am now under Birmingham Midland Eye Center (Dr. Rauz) as they have access to serum and scleral lenses etc. If you ever find you're really suffering, the Midland Eye Center does have an emergency walk-in area.

Some things you can get the optometrist or opthalmologist to do is check the condition of your meibomian glands (whether they are expressing oils properly), check the lacrimal gland, do a fluorescein dye test (shows any dry spots) or schirmer test (checks how much moisture your eye has).

Is it possible something irritated that one eye specifically? If so you could try to do a saline eye wash, in case it flushes any irritant out. Also we don't have eyelid cleansers like Avenova in UK, but an equivalent with same ingredients is VitalBaby Aquaint or NatraSan (I use the former). I also use WaterWipes (preservative free wet wipes). I find that combination good for cleaning off any debris / irritants etc. At night I also pop on some iLast Hydraclean to moisturize the eyelids. I would just try one thing at a time though. Easy to get carried away and try too many things at once and not know which worked.

It's maybe more expensive but I find Thealoz Duo better for me in terms of artificial tear drops. I used to use Hyloforte. Be sure to get the preservative free versions. I use many other things, but it depends on your main complaints as to if you'd need to try other treatments. The fact that you saw an improvement though by using the warm compresses is a good sign though.

EDIT: I saw you say on another thread you do proofreading etc. and I guess this is something the optometrist should have picked up on if they did an eye test, but I'm wondering if one eye is struggling more with focusing than the other while you're working, and if that could be a reason for just one eye being affected. Just a shot in the dark. You could try using reading glasses which basically magnify the text a little, and if you have a lot of screen time while proofreading there are anti-blue light reading glasses you can get. There's also software like flux that reduces blue light on screens, similarly there are phone apps that do the same. Wherever possible making things white text on black pages is also better than glaring white pages, there are addons for browsers that will make things "night mode" "dark theme" etc.

[gilles]

As hokucat mentions, the blinking exercises are very useful, also in a way that can treat a root cause of MGD; which is partial blinking. It strenghtens the muscles needed to do a proper, full blink. I linked you a video explaining how to do them. You should do them throughout the day.
What I try as a way of massaging the thick oils as of this moment is pinching the eyelids.
While treating the symptoms you should also keep searching for the cause: e.g. oily skin, allergy, partial blinking, screen use, menopause (hormone inbalance, thick oil or not enough oil), etc.
Dr. Korb does an amazing job to explain all about MGD. This topic has mentionings about the videos.

EDIT:
also keep the 20-20-20 rule in mind, if working a lot on a screen. Every 20 minutes, try to look for 20 seconds to far objects (e.g. 20 meters distance).

About the one affected eye:
Maybe your non-dominant eye (for most people the dominant is the right eye, if I am not mistaking) has more difficulties focussing, as mentioned by PhoenixEyes. On screens the eyes have more difficulties with the adaptation - and estimation - of the distance causes by the artificial light, causing eye strain. Try to cover one eye and look at a far object, try it with the other eye too; do you see a difference (e.g. blurriness)? This could mean a refractive, weak eye muscle or lipid problem. I'm guessing a combination of the last two. I don't really believe in all that blue light stuff, as it is not really scientificly proven. For one, f.lux uses 100% blue light during the day on recommended setting. And blue light is healthy and needed during the day. I would rather believe that your eyes need to blink more often - which they don't when looking at a screen - rest and get used to look at farther distances again.

Other reason I could think of: which side do you sleep on? Maybe you press your eye on your pillow (scratching/pushing on cornea or bacteries/allergy of mites).

[KittyCat]

Hi Cat. I have several good friends who have had dry eyes as long as I have (10+ years now!), and none of them have developed into debilitating conditions like mines did. But it’s good you are being proactive because in almost any condition that can help in the long run. Am glad you are going to a specialist to get a more complete diagnosis.

You mentioned you are doing warm compresses and watch Dr. Korb’s videos. I’ve found in between and after doing my two 10 minute sets of warm compresses that if I do blinking exercises like Dr. Korb’s, it help give a little more moisture as part of the warm compress process. I think probably because since the meibum is more liquified by the heat, pressing the eyelids together expresses more than not doing these purposeful blinks. I have do two sets of 10 minute warm compresses because that makes it warm enough to liquify my meibum. Probably a good idea to do blinking exercises throughout the day, assuming your meibomian glands are getting clogged (if warm compresses seem to help you).

https://www.skyvisioncenters.com/201...exercises-app/

My condition was very severe for several years, but I’ve been able to manage it with diet and some treatments, so even if your condition gets worse that does not mean you can’t get better...here’s my journey I documented for Rebecca’s Dry Eye Stories in case you are interested, plus there’s many other stories there where people have been able to get better or manage their condition:

https://www.dryeyestories.com/new-bl...ous-deficiency

Hope your appointment goes well!

Hi Hokucat, thank you so much for the super helpful advice and kind words!

I've started doing the blinking exercises now and I think it's helping!

I remember when I first came across this forum a month ago, your success story was one of the first things I read and it gave me so much hope! So thank you!

My appointment at the specialist is a week today, I can't wait to find out what's going on! I feel completely in limbo at the moment, not knowing why I'm getting these symptoms and what I should be doing to treat them.

Interestingly, I've just had the results of my private at-home blood tests (Thriva), and I was expecting my inflammation levels to be high, but no! Completely normal. I thought dry eye was caused by high levels of inflammation but it seems I don't have that! I am deficient in folate though, which is important for eye health. So I'm going to start adding a folic acid supplement (you can become deficient in this in a matter of weeks as your body can't store it).

I also think stress/anxiety/hormones are strongly linked to my dry eye, as this all started a month after lockdown due to Covid which I was not handling well at all. I had become so anxious and stressed that I was having regular panic attacks and shaking and tightness in my chest, pretty much morning to night every day. Then wham, dry eye symptoms started. I don't think it's a coincidence!

Anyway, I'm rambling a bit now!
I'll update here after my appointment!
Hope you're safe and well

Cat

[KittyCat]

Hi Kitty, I'm in Birmingham, though I was fast tracked through the NHS system due to the sudden severity of my condition, so I'm afraid I don't have much experience with private optometrists etc. I do think Aston University would be good to try though, I reached out to them in the past as they are one of the few places in UK with a Keratograph which is good for checking the condition of the meibomian glands. Dr. Wolffsohn who is based there was very helpful. I started off under the care of the ophthalmology clinic at Queen Elizabeth Hospital (Dr. Kolli), am now under Birmingham Midland Eye Center (Dr. Rauz) as they have access to serum and scleral lenses etc. If you ever find you're really suffering, the Midland Eye Center does have an emergency walk-in area.

Some things you can get the optometrist or opthalmologist to do is check the condition of your meibomian glands (whether they are expressing oils properly), check the lacrimal gland, do a fluorescein dye test (shows any dry spots) or schirmer test (checks how much moisture your eye has).

Is it possible something irritated that one eye specifically? If so you could try to do a saline eye wash, in case it flushes any irritant out. Also we don't have eyelid cleansers like Avenova in UK, but an equivalent with same ingredients is VitalBaby Aquaint or NatraSan (I use the former). I also use WaterWipes (preservative free wet wipes). I find that combination good for cleaning off any debris / irritants etc. At night I also pop on some iLast Hydraclean to moisturize the eyelids. I would just try one thing at a time though. Easy to get carried away and try too many things at once and not know which worked.

It's maybe more expensive but I find Thealoz Duo better for me in terms of artificial tear drops. I used to use Hyloforte. Be sure to get the preservative free versions. I use many other things, but it depends on your main complaints as to if you'd need to try other treatments. The fact that you saw an improvement though by using the warm compresses is a good sign though.

EDIT: I saw you say on another thread you do proofreading etc. and I guess this is something the optometrist should have picked up on if they did an eye test, but I'm wondering if one eye is struggling more with focusing than the other while you're working, and if that could be a reason for just one eye being affected. Just a shot in the dark. You could try using reading glasses which basically magnify the text a little, and if you have a lot of screen time while proofreading there are anti-blue light reading glasses you can get. There's also software like flux that reduces blue light on screens, similarly there are phone apps that do the same. Wherever possible making things white text on black pages is also better than glaring white pages, there are addons for browsers that will make things "night mode" "dark theme" etc.

Hi PhoenixEyes,

I've just had an email from Aston Uni to say they're currently doing risk assessments to make sure they're Covid-secure before opening back up again, hopefully it will be weeks rather than months before I can go and see them! In the meantime, I have an appointment a week today with Alison at BBR Optometrists who's going to do a full consultation. She already said on the phone it sounds like Lipiflow and 4 IPL sessions might benefit me. I think Aston Uni does IPL but not Lipiflow.

Thanks for your recommendation of VitalBaby Aquaint! I've ordered some from Amazon, so cheap! And to think I was going to be spending twice as much for half the size on Blephasol!

Since you've mentioned eye strain in the one eye, I definitely feel like the muscles around my left eye are tight and strained, so thanks for this too, something I'll raise next week at my appointment.

I've got flux and eyecare on both my computer screen and on my phone, and I'm taking regular breaks and doing blinking exercises, so I think I'm doing the best I can in terms of screen use.

Cat

[KittyCat]

As hokucat mentions, the blinking exercises are very useful, also in a way that can treat a root cause of MGD; which is partial blinking. It strenghtens the muscles needed to do a proper, full blink. I linked you a video explaining how to do them. You should do them throughout the day.
What I try as a way of massaging the thick oils as of this moment is pinching the eyelids.
While treating the symptoms you should also keep searching for the cause: e.g. oily skin, allergy, partial blinking, screen use, menopause (hormone inbalance, thick oil or not enough oil), etc.
Dr. Korb does an amazing job to explain all about MGD. This topic has mentionings about the videos.

EDIT:
also keep the 20-20-20 rule in mind, if working a lot on a screen. Every 20 minutes, try to look for 20 seconds to far objects (e.g. 20 meters distance).

About the one affected eye:
Maybe your non-dominant eye (for most people the dominant is the right eye, if I am not mistaking) has more difficulties focussing, as mentioned by PhoenixEyes. On screens the eyes have more difficulties with the adaptation - and estimation - of the distance causes by the artificial light, causing eye strain. Try to cover one eye and look at a far object, try it with the other eye too; do you see a difference (e.g. blurriness)? This could mean a refractive, weak eye muscle or lipid problem. I'm guessing a combination of the last two. I don't really believe in all that blue light stuff, as it is not really scientificly proven. For one, f.lux uses 100% blue light during the day on recommended setting. And blue light is healthy and needed during the day. I would rather believe that your eyes need to blink more often - which they don't when looking at a screen - rest and get used to look at farther distances again.

Other reason I could think of: which side do you sleep on? Maybe you press your eye on your pillow (scratching/pushing on cornea or bacteries/allergy of mites).

Hi gilles, thanks so much for your advice! I've definitely noticed an improvement since doing blinking exercises (I've started feeling moisture from time to time when I do forceful blinking, so it must be doing something!).

In terms of cause, I really have no idea! I haven't had LASIK, not menopausal, I did wear contact lenses regularly but haven't worn them regularly for over 4 years. I think it is probably a mixture of screen time due to work and possibly anxiety/stress as the symptoms came on around a month after lockdown, where I became incredibly anxious (panic attacks, obsessive cleaning/checking the news/not leaving the house/tight chest/not sleeping etc). I'm starting to believe there is a big link between mental health and dry eye. I have read that people seem to have more symptoms when they are feeling stressed/down/anxious. Again, something to look into.

I do also sleep with my face nuzzled into my pillow, on my left side! So there is also the possibility I'm doing some damage that way too! I've bought some EyeSeals 4.0, but they seem too big for my face! They're also super uncomfortable for me, so I'm just sleeping with a regular fabric eye mask which seems to be helping.

It's such a puzzle to find causes isn't it! It could be so many different things, and probably is a whole jumble of stuff! I'm sure as heck going to do my hardest to get to the bottom of it though!

Cat

[Meibum Ian]

I have an appointment a week today with Alison at BBR Optometrists who's going to do a full consultation.

How did it go?

[KittyCat]

Hi Meibum Ian
Alison diagnosed me with MGD, and moderate dry eye and has booked me in for IPL. No signs of bleph at all. She was really nice. The only thing I'm not too happy about (and I'm going to email her tomorrow) is that she only used the TearLab osmolarity checker thing (305 in my worst eye, 295 in my right eye), and used the slit lamp. According to the BBR website, I should have had far more diagnostic tests (see screenshot). My blinking pattern wasn't looked at, at all. Did you have the same thing happen to you?
For £105 and a 3-hour round trip, I was disappointed when I realised but I was already halfway home!

Edit: TBUT is 3 seconds in left eye and 6 seconds in right eye, which seems pretty severe!! But I'm only classed as moderate. I'm so confused by the grading and all the different nuances of this whole condition. Alison did say not to focus too much on the numbers which can vary day to day, and that it's far better to focus on how I feel.