Nightime dry discharge suffocates

[yuckyIsand]

Anyone here who can help me with a positive answer I would be forever in their debt.

My profile...I'm a middle age man, a consciously healthy eater, lots of fiber fruits and veggies, drink plenty of water, I consciously don't eat late in the evening, I get moderate exercise, non-smoker since the 80's, maybe 5lb overweight.

The nighttime suffering has been going on for 3.5 years. Largely because of the stress strain tied to the repeated loss of REM sleep many friendships have been lost and numerous family relationships have suffered. Jobs have come and gone and gotten increasingly less meaningful in terms of personal satisfaction and financial benefit. For over 3 years I've had to deal with either lack of or inconsistant sleep. Then often I have to figure out how and where to have a mini-nap in the daytime just to have enough energy to finish that day. To summarize, life completely sux. I'm slowing coming to a perception that life isn't worth living.

When I lay my head horizontally on a bed, invasive dry crud around the circumference of my eyes, the punta, the lacrimal ducts and ethmoid sinuses. I think I don't need to tell you the inside corners of your eyes act as vents for nasal breathing. Each and every night when these glands get glossed over with this crud an all night battle against suffocation commences. I wear a CPAP for apnea that I keep immacuately sterile. Opthomologists have had theories regarding air blowing around CPAP masks causing dessication. The nasal-only CPAP masks sometimes get a lot of heat from opthomologists. So I went to a full face mask - both mouth and nose. The results were and continue to be the same.

My family doctor thought maybe this was an allergy issue, so he referred me to an allergy doctor. I had the full arm blood prick. Zero reaction. Next this allergy doc referred me to an ENT. The next day I was lying on my back getting a sinus CAT scan. The results? There is nothing blocking my sinuses that could be the source of dry, or any discharge.

Over the last two years my family doctor has told me "I'm obsessing", a Cincinnati opthomologist has suggested that I "can't do anything about it so I should just learn to live with it" and most recently a smart alack Dayton doctor's assistant had the GALL to insinuate that I "must play around with my face at night a lot." I happily invite any or all of the 3 aforementioned folks to sleep a night in my slippers.

During the daytime I am fine in terms of discharge. During the daytime I am generally fine except for just a little building pressure in the inside corners of the eye around the punta. These problems begin once I lay my head down, no matter if I'm home or somewhere else, no matter if I lie down day or night. The dry discharge is often so extreme that if I turn my head to the side of the bed I can plainly hear it hitting the carpet like a shower of very fine grit.

Thanks and Happy Holidays to all!

[Rebecca Petris]

Hi yuckyIsand,

I've been going through your posts to try to get a clearer understanding of your story. I'd like to help if possible to see if there might be any new approach to this that could be helpful but right now I just have more questions than answers.

First off, I don't understand quite where you're at with dry eye symptoms in general (if applicable). Other than the initial posterior bleph diagnosis what other diagnostic information can you share? You've mentioned something about goggles during the day at the computer if I remember right and also waking up extremely dry but can you please elaborate on where you're at diagnostically with your tear production, MG secretions etc to the extent you know.

Second, what exactly is it that keeps you from sleeping? You're going on about crud developing but why is that keeping you awake. Is it pain, or what? Then there's this:

I think I don't need to tell you the inside corners of your eyes act as vents for nasal breathing. Each and every night when these glands get glossed over with this crud an all night battle against suffocation commences.

Huh? I don't understand at all. Suffocation??? All kinds of people have all their puncti either plugged or cauterized, and it does not interfere with breathing. What am I missing here?

Third,

Opthomologists have had theories regarding air blowing around CPAP masks causing dessication. The nasal-only CPAP masks sometimes get a lot of heat from opthomologists. So I went to a full face mask - both mouth and nose. The results were and continue to be the same.

Yes that's a common problem with full face masks. But you said in an earlier post that you were using Tranquileyes with it. Are you still? Having your eyes covered would prevent air from blowing into them. However, I've known of some rare cases where the cpap was actually blowing so forcefully up the nasal passages that it was coming OUT through the puncti and that is a different animal that causes its own problems.

Fourth, have you seen a really good corneal specialist. You have mentioned a family doctor and three ophthalmologists but haven't mentioned whether they were specialists. You really need someone who can do a better job of diagnosing some more subtle problems (or better yet get your charts from all of them and see what you can glean from the records).

Fifth, you had said you responded very well initially to Azasite. Then hit a snag, but were given a different method of application. What happened? Did it stop being effective?

[yuckyIsand]

Does my head have 2 extra holes?

Thank you for taking time to respond.

My initial diagnosis in late summer '07 was conjuntivitis. The family doc prescribed amox which was of course 110% useless. Big mistake going there.
My eyes are somewhat naturally moist so long as my head is in the vertical position. Once I lay my head down I dry up and all the aforementioned crud problems start.
Why am I waking up, you ask? The crud literally suffocates me! Probably four to five times each night to early morning I am forced awake gasping for breath. On my nightstand I've stockpiled Ocusofts. The ability to breathe NASALLY resumes the instant debris is removed from the openings of the puncti. Do I have two extra breathing (vent) holes I didn't know about? Please tell me I'm not a freak of nature.
Yes I still use the Thermoeyes nighttime mask to help prevent dessication. The heated bead in water deal frankly started to drive me crazy because the bags aren't very durable.
Regarding the CPAP this was the exact reason why in 2010 I paid straight out of my pocket for a...(sigh)... 3rd sleep study. The sleep specialist & I wanted to determine if the CPAP pressure setting may have been calculated incorrectly. After the data came back the CPAP was adjusted from 6 to 5. However upon using it, the exact problem persisted.
At one point in time I believed Azasite might be my salvation from misery. That salvation lasted maybe 3 weeks to a month, then the trend gradually shifted back toward misery. In fact it seemed as though after that first month or so, Azasite could have actually been complicating matters. I would spread a mini-bead of Azasite around the meibomian glands and onto punti, then within half an hour it's as if some areas of m glands and both punti begin eruptions of dry cakey crud.
I've gotten dizzy going back and forth from 2 family docs, I don't remember how many opthomologists, 2 ENTs, 1 allergy doc, and 1 dermatologist. However recently my family & I talked about somewhat desperate measures including looking for some help at the Cleveland Clinic. Even the sound of that place sounds expensive.
I have not been to a corneal specialist. Do you really think this might be an eye problem?

Thanks again!
Happy Holidays!

yIs

[littlemermaid]

When you press under the puncta during the day, does gunk come out? Is there any chance you've got infection spreading down into the sinuses? It wouldn't even have to be bacterial. Do you get the discharge sleeping in all environments? That way you would know whether it's allergic. Has anyone sent the moist crud on a swab to a lab with suspicion of infection? It's difficult when we fall between the gaps of different specialisms.

On the sleep and work problems, can your general practitioner recommend some talking therapy? It sounds as if you would like that for support while you're looking after your eyes.

The reaction to Azasite is very interesting. We had a response in the MGs to topical Adapalene on the chin, bizarrely, although this is a topical retinoid which changes sebaceous glands - previously blocked glands exuding golden fluid. This freaked me out and we stopped, although I wonder what your azithromycin is actually doing. Do you think its useful?

What do you mean 'lacking washing faciliites'? Is this sebaceous blepharitis? And this is a difficult question - can you show someone you trust the eye sand routine? Just in case it's a repetitive behaviour you could use some help with.

[yuckyIsand]

After 3.5 years of conflicting stories by different doctors I honestly don't know what's going on. I'm so freaking tired of dealing with these doctors who pretend they care but really don't, then they happily shove that day's receipt into your hand just before they escort you out the door. What I know for sure is this problem continually causes me to get next to no sleep every night, so during the day I aggravate most everyone I come in contact with.