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Hi everyone - My story so far

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  • Hi everyone - My story so far

    Hello everyone,

    I am reading in this Forum for quite a while now and there have been many helpful posts in it which helped me in a difficult time. So first of all a thank you to this community.

    I am 36 years old and living in northern germany. My first dry eye symptoms started in 2017 where I had an appointment at a local optmetrist including a meibography which showed some significant loss of Meibomian Glands, which I didnt know even exist at that time. The result of the appointment was that I heard about me having dry eyes and receiving some drops with hyaluronic acid. Back then I was still wearing soft contacts, which I started at the age of 16. The symptoms got better and I was pretty comfortable most of the time. In the beginning of 2020 this changed though.

    The contacts I was wearing for 10-12 hours a day, I know now that this was way too long, were more and more uncomfortable. Glasses were not an option for me at work/during the day due to my high prescription. Unfortuately I had low self confidence wearing glass and the sight was also difficult to adjust to compared to the sight with lenses.

    Corona started and our company allowed working from the Home office which made it possible to use the glasses more frequently. But that was not a solution I was anxious how to proceed in the future when contacts dont work anymore. My thoughts mostly revolved about this topic which also started to affect the family life. I decided to get lens implants, they are called ICL from Staar Surgical, and they were successfully implanted in July 2020. The sight is excellent and also the clinic I was at was fantastic.

    Before the operation I wanted to make my eyes as healthy as possible and I visited several dotors, both private and insurance funded. Most of them unfortunately had no idea of this disease at all but I found one doctor in Hamburg who was at least ok. I had 4 sessions of IPL there and manual expression. Meibography also showed gland dropout of around 50% although his device had a really low resolution. My TBUT was ok, I dont know the number anymore but it was >10 seconds. There were no additional tests like Schirmer etc. The doctor also proposed scleral but I feel that was way too early and that there is alot of other stuff to be tried first.

    So at that stage i was diagnosed with MGD but my Lid margin didnt look inflamed.

    Mid of this year I was also diagnosed with depression probably due to a very high workload and the anxiety of what will happen with my eyes, will I be able to wear contacts or will I get the operation. Additional to that being pretty much bound to the house during Corona time. Probably it all added up. Meanwhile I am good again, some days are better and some are not but I am able to enjoy life again and also work.

    The only problem in that regard is me, on not so good days, being very sensitive in terms of my eyes. I retreat inside myself and just watch/feel/listen to how my eyes are feeling over the weeks and monthats I learned how to deal with that better by geeting out and doing something. Still pretty annoying and I dont know myself like that, It is difficult to adapt. I am also taking Escitalopram 15mg per day, but I want to stop it end of the year.

    Starting in 2017 I sometimes had a foreign body sensation when not wearing my lenses. When wearing my lenses that feeling was not there. But there were also months with no foreign body feeling. But with lenses the eye always felt protected, difficult to describe.

    My doctors prior to the operation always told me my eyes are irritated and said it will be due to the contact lenses. My hope was that after the operation that irritation would be gone because the lenses are not inside the eye anymore.

    The eyes got whiter but there are still issues. The symptoms are not there all the time and not in both eyes at the same time or at least more prominent in one eye so that I focus more on that eye. Sometimes its the left and sometimes the right eye. My main symptom is a foreign body sensation. It comes and goes and pisses me off. That symptim is there when I blink. Luckily I have no problem with computer work or TV. I put the settings on my monitor to read/night mode. Generally I feel pretty symptom free when watching TV or being at the computer which is not a give as I learned from the forum.

    The second symptom I have sometimes is a burning. With the symptoms I feel they are worse when my mood is bad but on the other hand I feel that my mood is better when the symptoms are low. I guess thats normal.

    What I am doing right now is:

    - Blephasteam in the evening and massage afterwards, in the morning I massage the eyelids after showering. I clean the eyelids afterwards with NatraSan HCOL
    - blinking exercises
    - 4 capsules of Omega 3
    - 1 capsule of turmeric
    - 2 capsules of Xevakrin (german brand with some ingredients supposed to increase tear production, but i just started 10 days ago)
    - green tea with lemon ( i regularly forget that)
    - liposomal spray 1-4 times a day
    - drops i tried alot of stuff like Evotears, Cationorm, HyloGel etc but they dont offer me much relief. I am not sure but I think my eyes feel better without. Sometimes I use Herba-Vision though

    Generally germany has very few good places to go in terms of dry eyes but i luckily found one 2 weeks ago. I had a good examination with the Lipiview device which showed gland loss, more on the lower one than on the top lid. My LLT was ~70 and I had many partial blinks. At that doctor she also found some wrinkles at the conjunctiva and some statining. She was the first one to do a Schirmer test aswell and Schirmer one was 25mm+ but the Schirmer two was only 3 and 7mm. TBUT was again ~10-12sec. Tear Meniscus was 0,15-0,20mm.

    The next step will be to get lower punctum plugs in 4 weeks. Besides that I didnt receive a treatment plan differing from what I am already doing.

    I am wondering why my basal secretion is low compared to reflex tearing, maybe it is the Escitalopram.

    What I would like to try are some anti inflammatory drugs but my regular eye doctor said that they are not for me when I asked and the doctor in Hamburg said that Azyter is only for bacterial conjunctivitis. From what I read there is always a inflammatory component to dry eye, shouldnt it be treated even if it is subclinical? What are your thoughts?

    That is a wall of text, to anyone who reads this: Thank you. It was good to write it down.