Blinking pain/ Pain with closed eyes and LWE

[why_eyes_why]

Hi all -

I have had moderate/severe dry eye since February. It all escalated rather quickly. Thanks to Restasis, AIP diet, Azithromycin, punctal plugs and life style changes, my eyes are no longer dry and my corneas feel pretty good. However, right before I had my upper plugs put in I was developing lid wiper epitheliopathy which causes blinking discomfort. For 1 week after my plugs I felt amazing. However, the friction feeling returned upon blinking. It started off as a nuisance, and over the course of 2 months has become painful and raw. It especially hurts when I close my eyes which has made sleeping impossible.

I just started my IPLs but I am worried that the constant friction and sleep deprivation will acquire more inflammation and delay my progress with IPL. I ordered rebamipide from Japan as I read that its one of the only meds for LWE. At this point I'm desperate, and worried that taking out my plugs will do more hard than good.

My theory is that the goblet cells on my lid wiper (which allow it to glide smoothly over the eyes) are being bathed in too many salty tears. Like putting salt on a slug. I think my osmolarity is good, but the sheer quantity of salt might just be too much for the delicate lid wiper. Also usually the MGs provide a barrier between the aqueous tears and lid wiper, but right now I have very low oil production. Not very many people seem to have this exact problem. Any advice would be appreciated

[cat]

Hello, that sounds really difficult - do you have those big rigid punctal plugs? Those didn’t work for me, they slid out and I didn’t try to put them back as they rubbed my eyelids too much. I’ve been fitted with dissolvable plugs that last a few months and they don’t have any side effects for me. I’m not a doctor but the eye specialist I went to said ultra-salty tears were bad too - he said if you cry them wash it out with saline or preservative free eye drops - I hope it might help you. Also, I managed to get thealoz duo on prescription and it is hypoosmolar so may help more according to the optometrist doing my IPL for me

best of luck and take care
cat

[why_eyes_why]

thank you. yes i did a lot of crying a few weeks ago, im sure it did not help. im so so worried this damage will be permanent. theres so little info on lid wiper epitheliopathy. ive been using vitamin A ointment, which seems to work for some people but hasn't worked for me yet after a few months. I do have the rigid plugs, and have had no problems with them falling out. Im going to ask myt doc about flow control plugs, since I tear up so much with all my plugs. If I didnt have the plugs, I would need to blink constantly which would probably make my lid wiper situation even more mad. so hard to know what to do in this situation!!