Epi-Lasek 12 Months Ago

[Nowty]

I have been reading this forum over the past few months and I think its time for me to join in and share my problem and experiences. I suffer from dry eye symtoms and have recurrent corneal erosions on waking.

I had Epi-Lasek 12 months ago and had no idea what the next 12 months would bring. I seem to have had similar experiences to many on this forum, I had laser treatment, I was the “perfect” candidate and I have had indifferent aftercare from my laser clinic.

I experienced my first erosion about 3 weeks after my laser treatment and I was told to use Viscotears at night. Even with this I had regular erosions on waking so I was told to use Lacrilube. Then I had a severe erosion, 3 days of on and off severe pain ending with me being almost blind in my left eye. It was Xmas and the clinics were closed, luckily my eyesight came back over a period of about 10 days. The clinic told me I had a TBUT of 2 seconds and I had dry eye. They fitted temporary punctual plugs and I was told to continue with Lacrilube but also to use Celuvisc.

Another time I saw the surgeon, he examined me, he told me the surface of my eyes were fine and that my problems will eventually pass. Just keep using the Lacrilube, Viscotears and Celuvisc.

I have good days and bad days, sometimes I go most of the day with using anything, but I usually need artificial tears in the evening, always Lacrilube before bedtime, and Celuvisc several times during the night. But other days my eyes are itching, sore, burning, etc all day no matter what artificial tears I use.

I have not been to my GP, I am rather embarrassed about it being self inflicted and hearing about the NHS experience from many on this forum.

However this week I went to see a private Optometrist specialising in Dry Eye conditions. He was recommended on this forum and he started to make some sense about my situation. He determined that my Meibomian Glands are clogged up and are not producing oil, he even took a photograph of them to show me on a monitor. He said that I have a reasonable amount of aqueous tears but I am mainly suffering from evaporative dry eye and subsequent damage to my mucus layer. He said I probably had this condition for many years and that I should definitely not have had laser treatment.

Rather that continuing with all the “gloop” to just relieve the symptoms, he said I needed to correct the underlying problem, i.e. I need to get my natural eye oil flowing again. So now my regime is going to be lid scrubs, regular hot compresses and Theratears for the next couple of months. I am going back to see him in the New Year so I will let you know how I am getting on.

At least now I have some confidence that I know what my problem is and that I can do something positive about it. I just cannot believe nobody in my laser eye clinic had noticed this.

[Guest]

Nowty

The moment I saw the title of your post and that you were in th UK, my immediate thoughts were, of my not another statistic, then immediately my heart went out to you.

All I can say to you is that I am another 12 months in front of you and things do get better. I had my 2 year epi-lasek anniversary a few days ago.

I have had some pretty tough days along the way but I can assure you that my second 12 months were far better than my first.

Like you, I have tried the limited resources we have in the UK, however, Lacrilube was never one of my favourite products.

I found the most successful thing for me was to use Genteal Gel (not directly available in the UK - I picked up a load on a trip to Oz) and taping my eyes closed of a night with perforated, low allergy medical tape (available from Asda).

I did this for months and found that it really helped with the erosions. Of a morning before I removed the tape, I poured non preserved saline solution (steripods) in my eyes, then removed the tape, then gently opened them.

I found this also helped reduce the erosions.

I certainly wish you well and can only encourage you that things do improve with time.

If you have any questions, please PM or email me I will be happy to help.

If you feel that you have been dismissed by the clinic, all I can say is persevere, I don't know who you went to but it sounds very similar to my experience.

Warm regards and hang in there.

Ian

[brd888]

Hi.

Ian,
I thought the problem with laser surgery was damage to nerves on the ocular surface which reduces lacrimal tear responce. I.e. aqueous deficiency? Can post laser problems include oil deficiency?

Nowty,
For the record how much was your laser treatment? Was it the 400 per eye or the "safer" more expensive clinic? Also you should note that many people, myself included, have the same problems as you without any laser surgery - I have had problems for nearly 2 years too and have no idea what triggered it - maybe just aging.

Regards,
Bruce

[Rojzen]

yes, damaged blink reflex can reduce oil secretion

brd88--I've been loving the spunk in your postings, because prolonged dealings with eye docs who don't even rate dry eye and its often devastating symptoms as worthy of acknowledgment can cause the kind of depression and time-wasting I experienced when I went through, in my early phase of DES. . .Yes, so long as the corneas weren't eroding seriously, and retinas and optic nerve looked OK, the eye docs thought I was nuts... I once had the displeasure of reading the medical report prepared by one of the first docs I saw: he spent the whole text commenting on how strange it was that I was weeping from pain, when he examined me.

Thankfully, times are changing, but finding a doc who actually is INTERESTED in dry eye is everything. . .Here in the States, as Rebecca has pointed out, the optometrists seeming to be movingway ahead of the ophthalmologists, in the area of DES patient CARE and diagnostics. . .

Anyway, Dr. Scheffer Tseng, of the rare breed who has cared deeply about dry eye, has said, at least to patients, that he feels that when the ocular surface nerves are damaged by LASIK, this desensitizes the cornea, which, in turn, slows down the blink reflex. Reduced blinking means the meibomians are not tapped/stimulated much, and they can, as a result, atrophy or sicken, altering dramatically the secretion of lipids on to the eye surface. . .That seems very logical to me. . .Perhaps it helps to answer your question. . .

[Nowty]

It was Optimax, I think the same clinic chain as pratstar and hangus. I dont think the lower price meant an inferier procedure, as it went perfect and I now have perfect vision. Its just that they did not notice (or care about) either before or after somthing so simple that my oil glands were/are not working very well. The private Optometrist I went to see last week noticed straight away and reckoned that I have had this condition for many years and therefore should have been refused treatment. I obviously would not have gone through with the procedure if I had known that beforehand.

[Guest]

Nowty,

I agree with you that a lower price does NOT suggest an inferior procedure or patient care. After all, if this was the case there would be many others with problems and the chain would be out of business. This is clearly not the case and they are now one of the biggest providers (if not the biggest) in the UK.

For the record, I do not have any vested interest in this company, nor do I advise for or against the procedure/company as I believe it is up to the individual to make an informed decision based on fact. All I can relay to people is my experience and whilst I don't live a life of regrets, let's just say if I had my chance again, laser eye surgery wouldn't be high on MY list.

If you want to send me a PM or email, I can give you a contact at Optimax that may be able to point you in the right direction.

I have found that things have improved in year 2 rather than year 1. Whilst i still have some crap days, there are far more better days than bad days NOW.

I agree that laser surgery damages the surface but I think a poor eye surface then develops into other symptoms, I could be wrong on this.

If you have some sort of MGD, then warm compresses and lid hygiene may help you bring this under control.

Ian

[Nowty]

Progress update for you all. Its been around 6 months since I last posted and I am now around 18 months post epi lasek. My situation has definitely improved after the 12 month stage, although I still have a chronic condition requiring daily treatment, especially during the night. I have only had around 2 or 3 painful erosions over the last 6 months and I rarely have days were my eyes are constantly burning or itching any more.

After using just about every drop available I now have a stable regime of treatment (optimised by trial and error) as follows,

On Waking :
Lid scrubs, sometimes hot compress (if I have the time) and a whole vial of Theretears to wash the eyes out.

During The Day :
Theratears several times during the day, sometimes I can get through the day with hardly any but on rare occasions these are not good enough and I have to also use Viscotears.

Evening :
My eyes gradually become more dry after 6pm and I need more frequent Theratears or even Viscotears if the Theratears no longer work. I find that at this point, hot compresses only seem to make them worse.

Before Bedtime :
A little Viscotears, followed by a little Tears Naturale PM Ointment, followed by a drop of a mixture of Endura and Celuvisc.

During the Night :
A mixture of Endura and Celuvisc, a drop every 2 hours or so if I awaken.

Writing down this regime sounds horrendous and it costs me approx £1000 per year. But it just seems second nature to me now and I hope that my condition further improves for me to reduce down the drops.

[Nowty]

Another progress update after 2 more years and maybe some hope to others thinking that their situation will never improve. I am now over 3.5 years post epi lasek and there has been more improvement. Even so I still have a daily regime or else my eyes become gritty as hell during the night and a recurrent erosion may occur on waking. Because of my continued regime I only have an erosion maybe once every 4 months or so and they are now only mild to moderately painful, not the red hot poker in the eye type, followed by days of megadrops that I experienced during the first year.

My current regime is similar to before but much more lighter,

On Waking :
Light lid scrub (less than before) and a few drops of Theretears (not a whole one anymore) to give the eyes a good lubricated start to the day.

During The Day :
Not much anymore, sometimes a hot compress or the odd Theratears eye drop as needed.

Evening :
My eyes still gradually become more dry, but only late in the day now, usually around 10pm or 11pm. If its going to be a late one, then Viscotears may be required.

Bedtime :
Similar as before (but much less dosage) or the risk of an erosion is still too great. A little Viscotears, followed by a little Tears Naturale PM Ointment, followed by a drop of a mixture of Endura and Celuvisc.

During the Night :
A mixture of Endura (I think this is now not available but I bought up 2 years worth and I dont know what I will do when I run out cos nothing else comes close !) and Celuvisc, usually now only require one or two re-applications during the night.

[Nowty]

Another progress update 4.5 years post Epi-Lasek and about one year since my last update.

I still seem to be gradually improving and my errosions are proabbly down to maybe 1 every 6 months or so, although if I stopped my nightime regime I think I would be having more.


My current regime is similar to before but again slightly more lighter,

On Waking :
I dont really do the full lid scrubs anymore but I do bathe my eyes with warm/hot water and rub the margins with a bit of loo roll, followed by one or two drops of Theretears. If I dont use the Theratears then my eyes can feel very gritty for a time but they do generally improve on their own if I forget to use the drops.

During The Day :
Not much anymore, sometimes a hot compress or the odd Theratears eye drop as needed but normally nothing more is needed. they still feel gritty sometimes but I can get by without much treatment.

Evening :
My eyes are better than a year ago, usually I can go the whole day without further treatment but sometimes I still need some Theratear drops.

Bedtime :
I still need this, Viscotears and a little Lacrilube type ointment.

During the Night :
As Endura is no longer available I am using normal Theratears but these are not as effective and I find I am using these drops more often and find my eyes more gritty.

So my problem is the night, I still have a small stock of out of date Endura (Allergan Dry Eye Therapy preservative free) left which I keep in the fridge. Have tried to wean myself off them over the past year but I still find nothing comes close to the relief they have given me.

[joanna]

Hi Nowty,
How are you now?
I'd love to hear there is new progress.
Almost two years after epi-lasik my RCE became worse. Your story give's me hope it can be better.