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how much of the information/treatments for dry eye is unproven and/or nonsense

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  • how much of the information/treatments for dry eye is unproven and/or nonsense

    Saw another useless eye doc the other day. Their brilliant advice to me was that "lid hygiene needs to be done 4x per day" - and strongly implied my problem would be under control if not for my own laziness!

    I've noticed a few eye docs/websites stating lid hygiene should be many times per day. I do lid hygiene twice a day and think lid hygiene is useful for most of us, but I think the idea that constantly scrubbing/washing the eyes is any more useful than basic sensible hygiene is absolute rubbish. I think constantly washing the eyes may in fact make some people worse.

    It makes me wonder how much of the information and treatments for dry eye are actually based on solid evidence and how many are unproven at best and absolute rubbish at worst. It's not just some of the "treatments" such as excessive lid hygiene like above, but the misinformation/myths actively spread about dry eye by eye docs and on the internet. For example two seconds after one doc told me I had scarring of my cornea from a previous ulcer, the doc spouted the standard garbage about how this couldn't harm my vision, I just needed to use lid hygiene and drops and my "flare up" would dissapear, and bleph/dry eye doesn't require any follow up or ongoing care from a doctor. These kind of "facts" are all over the internet.

    Regarding dry eye treatments, for example is there any actual proper studies done showing that the use of warm compresses X times a day improves the clinical signs of dry eye? I've no doubt that warm compresses can provide temporary symptom relief for many, but do they actually reduce inflammation, punctate keratitis and other signs observable to the eye doc?

    Has doxy ever been properly tested vs placebo for treatment of dry eye conditions?

    Does frequent use of artificial tears (some docs say every hour) vs less frequent use actually reduce the clinical signs or just provide symptom relief?

    Has anyone ever come across any studies that prove any of the stuff we do actually reduces the clinical severity of dry eye?

  • #2
    Warm compresses can actually exacerbate inflammation; what they do is get the oil moving, which can be good if you have plugged glands. If all else, the temporary relief is a good thing and if it allows less use of artificial treatments, that's good too.
    One of my doctors suggested using green tea bags (run cold water through them first) to help with inflammation. I don't do this a lot because it's time consuming but if I find myself "crying", I have found that rinsing my eyes well with saline and then applying the tea bags minimizes the swelling and the usual ramifications of "crying" don't last nearly as long as they do if I don't rinse / apply tea. When I'm having a particularly bad eye day, sometimes I follow my warm compress with green tea bags.

    One of my doctors suggests using drops every hour. The reason for this is to protect the cornea from dryness and therefore damage (it's not for comfort, etc). He told me that your eye can feel numb to the dryness and then, instead of using drops when you need them, you're unaware of the problem. This seems strange given all of the stinging, burning and ouchi-ness that we all feel so often but given that my left eye felt less dry but had more corneal damage when I started seeing him, it makes sense to me. I should add that I'm using serum drops (not artificial) and the abrasions have since healed.

    There are studies for some of the things we do but in many cases, they are simply anecdotal. Nevertheless, anecdotal does not mean there isn't validity to them. I think a lot of doctors simply don't know a lot about dry eye (dry eye hasn't been well recognized until fairly recently -- remember, right now there is only one drug, Restasis, on the market that specifically addresses dry eye and it only helps an approx 15% of the $9 billion U.S. market). Some doctors have done a great deal of research by reading papers, attending conferences, etc and some doctors just read the journals that come across their desk. You'll also find that doctors can be different based on their age (there are exceptions of course). Older doctors were trained one way and younger doctors have a different kind of training re: bedside manner, etc. Of course, there have always been older doctors with stellar bedside manner and initiative to learn things they don't understand and there are younger doctors that will be dismissive -- like anything else, you have to find the doctor that fits your needs and personality. Just like there are good and bad plumbers and real estate agents, there are good and bad doctors and what may be good for one person, may not be good for you. Unfortunately for those of us with chronic, out of the box issues, we bear a greater responsibility in weeding out the good and bad than those who have an easy-to-fix problem.

    Doxy as well as some of the other things dry eye patients are given, are antibiotics. If there is a bacterial component causing the dry eye, it would make sense that it would help. Remember, those of us on this site are chronic sufferers. There are many people that take Restasis, get plugs, take Doxy or simply use lid scrubs (singularly, not all of the above) that find relief. Aspirin treats a lot of headaches but it won't touch many a migraine. Just because a treatment doesn't help us, doesn't mean it doesn't help plenty of others.

    Specifically re: lid hygiene ... there are different schools of thought on that. One of my specialists is very against the scrubs, baby shampoo, etc because they are chemical. This is particularly true in his mind, for people with a lot of sensitivities (I'm one of them). Instead, he recommends using warm compresses followed by a Qtip "scrub" using sterile saline (not the contact kind but like this http://www.amazon.com/Medline-Steril...4459187&sr=8-3). Another specialist I've seen recommends the saline aforementioned but twice a week to use the packaged scrubs. Four times a day does seem excessive, particularly if you're using the chemical kind. If all else, I imagine it would irritate the delicate skin surrounding the eyes.

    I understand your frustration. Thankfully there are doctors out there who will go the extra mile, who take a special interest in dry eye and are working to find help for their toughest cases and thankfully, we have a site like the dryeyezone.com to support us and allow us to work collectively to find solutions.

    Comment


    • #3
      Hi PotatoCakes!

      I was just about to ask you about the sterile saline. It is impossible to find this product (at least for me) in stores, yet, there are a million to choose from for contact lense cleaning. Do you buy yours through Amazon? What size do you get and also, can these vials be recapped? I bought Ocufresh (I think it was called) and they were HUGE vials and could not be recapped. If I want to squirt some in to clean out my eyes, I do not need that much at once.

      Thanks -Neve

      Comment


      • #4
        re: saline -- I get mine at Pharmaca, a pharmacy here. Where I am, you need a prescription (weird and unnecessary, IMO, particularly since my insurance still won't cover it) but it is my understanding that in some states, you can get it without a prescription. The ones I get are just like the ones in the link and no, you can't re-cap them. I usually try to be super careful in keeping it clean and then store it upright in a shot glass in the fridge. I use 1 vial, twice - once each morning and on day 2, after use, I toss whatever is left.

        Comment


        • #5
          Hi Poppy,

          You may find this of interest to you: http://www.tearfilm.org/dewsreport/p...DEWS-noAds.pdf

          It's insanely long, but even just reading the chapter on management of dry eye can be really useful... It's all evidence-based and there is some discussion of that within the text...

          Comment


          • #6
            thanks for the article saag, it is interesting.

            Comment


            • #7
              Originally posted by SAAG View Post
              You may find this of interest to you: http://www.tearfilm.org/dewsreport/p...DEWS-noAds.pdf
              There was another really good article published by them about meibomian gland function, might be worth digging on their website for other articles. It did explain MG anatomy and function in great detail, and helped me understand how all the usual advice fits into what is known about gland function.

              Re. original question, I think all the things that are suggested have some evidence behind them (having looked into most of them at some stage); I think problems arise because most doctors don't recognise there the wide variations within the condition, diagnosis/treatment is not sufficiently tailored to the individual (hot compresses may work for one person's condition, make another much worse).

              The trouble is that MGD (and related dermatoses) simply aren't that well understood even by the experts, there are so many variables which mean the balance of symptoms is very complex and hard to treat. All we can do is progress by informed trial and error, trying different treatments and regimes until we find a combination that works.

              I'm sure doxycycline for ocular rosacea has been reviewed umpteen times; again, the action is not fully understood, it may have anti-inflammatory effect in addition to antibacterial. It works for some people, not for others, it probably depends on the exact form/subtype of the condition.

              Comment

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