newbie from the netherlands

[patrick]

hello everybody out there,

i'm patrick,38 years old,live in the netherlands and i'm 4,5 years post lasek. after browsing this great site for a while i thought its now time to introduce myself,and share my story with you. i also do have some questions which maybe can be ansewered by any of you. in 2005 i got my both eyes treated with the lasek method instead of the lasik method cause my doctor advised me this. he stated that the lasek method is less dangerous for complications than lasik. after the surgery my eyes healed perfectly,and it took about 6 weeks to regain my eyesight in both eyes. untill this moment my eyesight is stable and perfect. in the first 20 months there was no problem at all with my eyes and they were also not dry at all to (never been before surgery as well).Than things changed and my eyes felt dryer and dryer. i couldn't understand it because i never experienced this before. it took another year before i went to an eyedoctor to get my eyes examined. he did some tests and told me that my situation was not very good,but also not very bad to.
the schirmer test was ok.the doctor told me that i make more than enough tears,on the other hand the tbut test was not that good. evaporation between 5 and 10 seconds. he calls this moderate dry eyes. is this true? from time to time it feels like a severe condition to me! a blepharitis could cause the instability of the tearfilm he told me. he was not sure if there really is a blepharitis,but he advised me to clean my eyelids for the rest of my life twice per day with a babyshampoo dilution anyway! i don't react very good to the shampoo thing at all. my eyes turn very red and become very dry after every time i clean them the way the doctor told me to. Is there another maybe less agressive way to clean the eyelids? just hand warm water or so?
ok that's it for now. any people who recognize my story with themselves? sometimes i think i'm the only one who struggles every day with this agonizing condition. it makes me very sad. i hope my enlish is not too bad and that it is possible to read it i a normal way

greetings,patrick...

[calcan]

My advice is to forget cleaning the eyelids with shampoo or other special cleansers, because from my own personal experience, (and others')this only makes matters much worse. Clean your eye-lids with warm water instead.

[irish eyes]

Hi Patrick

You are not alone with this agonising condition and we understand why it makes you feel sad. I feel sad too although my problem is not caused by Lasek.

I agree with Calcan. Avoid these harsh cleansers if possible. Some baby shampoos can be very harsh and yet doctors continue to tell patients to use it. It made my eyes very sore so I never use it now. I even find some of the specially made products too harsh - such as Supranettes and Lidcare.

Try warm water, add a little salt and be gentle with your eyes.

[Rebecca Petris]

Hi and welcome.

Than things changed and my eyes felt dryer and dryer.

I would be very interested to know what may have triggered this. Any 'coincidences' you can think of? Did you move? change jobs? change any medication you were taking? It's possible the surgery made you more susceptible to dry eye and then something happened that pushed you over the edge into symptoms.

he did some tests and told me that my situation was not very good,but also not very bad to.
the schirmer test was ok.the doctor told me that i make more than enough tears,on the other hand the tbut test was not that good. evaporation between 5 and 10 seconds. he calls this moderate dry eyes. is this true?

There are two ways to measure dry eye: symptoms (how you feel) and signs (what they see under the slitlamp and in other tests). These two measurements often contradict each other. It is well known among specialists (though many doctors don't seem to 'get' it) that clinical signs alone are not a reliable way of measuring severity. If you want to know how you rank, complete the OSDI score and take it to your doctor.

Don't expect eye doctors to be sympathetic to the life impact of dry eye. Most aren't. But when a doctor says it isn't severe, what they really mean is, it's not threatening your vision, it's not going to cause a corneal ulcer, etc. So that's good.

he was not sure if there really is a blepharitis,but he advised me to clean my eyelids for the rest of my life twice per day with a babyshampoo dilution anyway!

Good gawd!

Find a new doctor, quick. Preferably, one who understands lid margin disease. This one doesn't.

I always used to use plain saline to clean my lids, with a cotton bud. Later I started using the basic Ocusoft foam, which I've always liked. Baby shampoo seems OK for some people, but it makes others worse.

If you do have blepharitis, then keeping the lid margins clean and doing warm compresses may help. I'd really encourage you to find a better doctor and get a good diagnosis if possible.

[patrick]

thanks for the replies!

Hello,

thanks for the kind replies. it is very encouraging to see that i'm not the only one struggling with my sore eyes,and that there are people out there willing to help and share. first a question for irish eyes;what does the salt in the water do when you clean your eyelids with this dilution? does it make the water sterile? i'm really willing to give it a try. anything better than the harsh shampoo trick. rebecca, you're interested in what might have triggered the dry eye symptoms. i really don't have a clue! why didn't it happen right after the surgery? that would have made some sense. it is not one of the suggestions you mentioned in your reply as well. but i can remember the first symptoms i experienced. one day i woke up and rubbed my eyes as i was used to do like anybody else. it hurt a lot in a particular way i cannot describe.i've never rubbed my eyes after waking up since then. initially i thought it could be the not yet fully healed scare of the surgery.but that is nonsense after almost 2 years post surgery i realize now. what scares me is why the dry eyes have become worse over time and not the other way around? normally after surgery the damaged nerves grow back on in time so as a result dry eyes should get less and less. not in my case. still my eye docter says 'give it time this condition will improve over time'. soon it is 5 years now.that is some serious time i would say. rebecca,i did the osdi test and the result is 20 points in twelve questions. 25x20 divided by 12 =41.6 as a result. seems like moderate to me. is 'moderate' hard to handle in daily life? what is the best way to cope with this? anybody here who has some suggestions for me? willing to try anything! ok that's it for now. thanks for taking the time to read my post!

greetings,patrick...

[irish eyes]

Hello,

..............first a question for irish eyes;what does the salt in the water do when you clean your eyelids with this dilution? does it make the water sterile? . ..

Hi again Patrick

Yes, it's just to make it sterile. Opinions vary but usually one mixes 1/2 teaspoon of salt to a pint of boiled water. I prefer to wait until the water has cooled before using it to bathe the eyes but mine are uber sensitive so I need to exercise a lot of care.

[patrick]

hi irish eyes,

thanks for your answer. i'm for sure gonna give the water and salt a try the next couple of days. i'll keep you updated with the results.

[ALK-O'd]

My situation is somewhat similar to yours (although I had ALK surgery) in that I had mild dry eye my first year after surgery, then my eyes FELT ok for about another 5 years, then became dry again and have gotten progressively dryer ever since. I have always gone for regular eye exams my whole life as I have been nearsighted since I was in pre-school. Prior to having surgery I never had any doctor say anything to me about having a poor quality tear film. However, almost immediately following the surgery and throughout my regular checkups during the following years I had more than one eye doctor tell me that I should be doing warm compresses regularly as the quality of my tear film was poor. In the beginning, I pretty much ignored the advice since I wasn’t noticing any symptoms. For me, the clinical signs were there in the early years following the surgery, but the symptoms didn’t become noticeable until many years later.

One thing to keep in mind is that unfortunately all eyes become dryer naturally as we age. As we grow older, our bodies produce less oil – 60% less at age 65 then at age 18 (see http://www.stlukeseye.com/Conditions/DryEyeSyndrome.asp). And of course, adding surgically induced corneal nerve damage into the mix sure as heck doesn’t help things either. I believe refractive surgery induces some level of tear film instability in more individuals than is realized. It certainly is possible to have mild dry eye and not even be aware of it. That, as I mentioned earlier was my case for several years. So, how many post-ops are walking around out there with a somewhat compromised tear film and aren’t even aware of it?? For these individuals it is likely that age-related DES will become noticeable earlier in life than had they not had surgery because oil production is already at a reduced level due to the nerve damage.

I for example am 37 years old and have severe dry eye but am perfectly healthy in all other aspects. I had my surgery 17 years ago. I’ve never had any serious eye infections or injuries (aside from the surgery). My symptoms have only become severe in the last couple of years. Given the slow but steady progression of my symptoms over the years, I do worry quite a bit about where I’m going to be in another 5 or 10 years. I am also 100% convinced that the refractive surgery I had so many years ago is the sole cause of my dry eye today.

I suspect that in another 10 – 20 years we are going to be seeing statistical data showing significantly higher rates of “age related dry eye” amongst individuals who had refractive surgery earlier in their lives. Hopefully by then there will at least be better treatments.