DRY EYE VETERNS!!! Advice please

[Ericska]

Hi SAAG,

I remember at one point we were talking about LacriLube. I cannot use it anymore and I have boxes of them at home. If you still use it, I would be happy to send them your way. Better for you to use them then go to waste on my shelf.

Let me know!
Ericka

[nori2015]

Hi Nori,

I am using Restasis, taking Omega 3 and Flax and use artificial tears every day and gel at night. I have been told and have read that if you use Restasis, you can't get plugs. For some reason they do not work together. I started Restasis last September and understand it takes 4 - 6 months if you're going to notice a difference. I am holding off on the plugs until I figure out weather the Restasis is actually helping me.

I am Aqueous Deficient so what helps me may not help you but if you're going to start the Restasis, start as soon as possible.

I also do cool compresses and hold the cold pop can to my eyes like DryinDenver as I too work on the computer all day. It's amazing what helps in a pinch. I find the cool actually helps me better than the warm. The warm is supposed to help unblock the glands and the cool is for irritation.

I have yet to find something that helps me during the night. The gel isn't enough. I find i get up at least twice a night to use drops otherwise I wouldn't make it through the night.

I'm also trying to be a little more gluten free as I understand that this causes internal inflammation as well. I'm not sure if it's the Flax capsules or the Restasis but since I started taking the flax capsules (3 a day), I have noticed a slight improvement. I see my opto in March to see if the Restasis has started working yet or not.

How do you get through the night?

Hi Ericska
Getting through the night is fine for me. What I do is I use a thick preservative free drop (clinical soothe, systsne ultra or any of the Hylo family) and I absolutely drown my eyes in them. I cover my eyes from top to bottom in them. Then I close my eyes while they are full of drops and under no circumstances do I open my eyes again until morning. If I do have to open my eyes again, I repeat the soaking process again. Once morning comes I very very gently open my eyes and thank god using this method 9/10 I get away without having an RCE.

If you are really struggling maybe you could do the above and tape your eyes shut with medical tape to be sure the eyes aren't exposed to drying effects.

What strength is your flax seed? I'm on 1000mg but no noticeable improvement for me.

I have plugs. And I got restasis yesterday. Opto never said I shouldn't have both. I will ask at my next appointment.

[meibomian]

If your eyelids are inflamed, it would suggest you have meibomianitis or inflammation of your eyelids, which is very similar to acne on the face, except it’s on your eyelids in this case. If warm compresses and eyelid hygiene don’t work, a course of oral antibiotics may help, along with a short course of topical steroids. In the setting of MGD (meibomian gland dysfunction), you should always check to see if your nasolacrimal system is open and functional. Even if there’s no anatomic obstruction, there may still be physiologic obstruction. Since your lacrimal system is basically a plumbing system, its maximum flow is determined not by its most open segment, but by its most constricted and least functional part. One of the most overlooked component of a dry eye evaluation is the lacrimal system. Hardly anyone mentions this vital part of the eye when discussing the differential diagnosis for dry eyes.
Even without knowing much about dry eyes, one can model dry eye in a very simple manner (it’s the standard differential equation model for those interested in the details). In a normal healthy eye, an adequate amount of tears is continuously made. The rate of production should match the rate of evaporation and rate of drainage. When there is a mismatch between production and loss, the eye will become as dry as a raisin or wet as a river overflowing its banks. We know eyes rarely turn into “raisins” except in cases of severe autoimmune diseases or from trauma or chemical burns to the eye. We also know that tears is more like a soup than a cup of water since there are wide variety of other substances or solutes dissolved or floating in tears, most of which do not evaporate to any appreciable degree. This pretty much leaves the aqueous, or water, component of tears as the only part that can leave the eye via evaporation. All other components either run down the face or leave via the lacrimal system. Therefore, if the lacrimal system is not clearing tears sufficiently, there will be a large increase in the concentration of solutes in tears (evaporation still occurs), including the inflammatory agents that lead to dry eye symptoms in tears. Based on this simple model, osmolarity testing as a marker for dry eye is actually detecting lacrimal obstruction in a significant number of those with high osmolarity! Ever wonder why having sinusitis leads to dry eye symptoms? That’s because the sinusitis blocks the lacrimal system at its “exit” point and causes an increase in concentration of the inflammatory components in tears. Ever wonder why ointments can make dry eye symptoms worse? The high viscosity of ointments blocks the lacrimal system. Reconsider using punctal plugs for dry eyes due to an underlying inflammatory process like MGD. Using this model, dry eyes can be address by decreasing the inflammatory components of tears and by equilibrating the outflow of tears to match its production. There are many methods to treat the former with steroids, Restasis, antibiotics, omega-3 FA, etc., but hardly a word about the lacrimal system.

[nori2015]

Meibomian, sorry just to be clear, do you think I should or should not have the plugs?

I got a corneal erosion last night in my good eye....I can't believe it, I was always so grateful that eye wasn't giving any trouble. I'm so disappointed :-(

[meibomian]

You previously wrote that the plugs didn't produce any improvement. Leaving them in would give you the risks - infection or exacerbation of your dry eye symptoms - without any benefit from a logical point of view.

[Ericska]

Hi Ericska
Getting through the night is fine for me. What I do is I use a thick preservative free drop (clinical soothe, systsne ultra or any of the Hylo family) and I absolutely drown my eyes in them. I cover my eyes from top to bottom in them. Then I close my eyes while they are full of drops and under no circumstances do I open my eyes again until morning. If I do have to open my eyes again, I repeat the soaking process again. Once morning comes I very very gently open my eyes and thank god using this method 9/10 I get away without having an RCE.

If you are really struggling maybe you could do the above and tape your eyes shut with medical tape to be sure the eyes aren't exposed to drying effects.

What strength is your flax seed? I'm on 1000mg but no noticeable improvement for me.

I have plugs. And I got restasis yesterday. Opto never said I shouldn't have both. I will ask at my next appointment.

HI Nori,

I have floppy eyelid syndrome as well, so my eyes open easily during sleep from pillows, etc. I tried press and seal and I found that irritated my eyes. I tried medical tape and, perhaps I'm doing it wrong but I didn't find it help my eyes closed. I use Ocunox ointment at night and when I wake up I use Refresh Celluvisc throughout the night.

My Flax is also 1000mg but I take 3 capsules daily and I take 4 Omega-3 capsules daily and Vitamin A.

I use the Restasis 3x a day.

Ericska

[nori2015]

Hi everyone
Just a quick update. I'm on restasis twice a day, maxidex (steroid) x 4 for two weeks, then x 2 for two weeks plus my artificial tears when needed. The steroid drops sting a lot, which none of my other steroid drops did in the past but I'm going to continue it as prescribed and hope something works. I was also told get omega eye from scope. Apparently better than other omega 3s. We'll see.
Another appointment in 6 weeks to see how this current regime works. So far no improvement on anything.....but it's only been a week I suppose.

[nori2015]

Currently feeling worse than before...will stick with it though, keep a diary and let the consultant know when I get to Moorfields in April.
God I really am getting impatient now :-(

[tess77]

How did you decide with the plugs? I got Ikervis (cyklosporin) from London last week, together with prednisolone drops, and do not know whether to have the treatment done with or without the lower plugs I got in December. I agree with some of the writers that it seems they worsen the inflammation, from having a normal tear production and the oily layer being the problem Iīm now on only 5 with Schirmers test (before plugs 25). Why did you get Restasis instead of Ikervis? What i s the difference? I have MGD, ocular rosacea, now tear defficancy and some gland dropout due to Accutane treatment for my facial rosacea. Desperate to find relief! Even on sick leave from work at the moment... Somebody please help!!

[nori2015]

How did you decide with the plugs? I got Ikervis (cyklosporin) from London last week, together with prednisolone drops, and do not know whether to have the treatment done with or without the lower plugs I got in December. I agree with some of the writers that it seems they worsen the inflammation, from having a normal tear production and the oily layer being the problem Iīm now on only 5 with Schirmers test (before plugs 25). Why did you get Restasis instead of Ikervis? What i s the difference? I have MGD, ocular rosacea, now tear defficancy and some gland dropout due to Accutane treatment for my facial rosacea. Desperate to find relief! Even on sick leave from work at the moment... Somebody please help!!

I got restasis as thats what my laser clinic offered me. When I was in London they said they'd have given me Ikervis, which is just the london version of restasis. Same product, different name. Check the label and let me know how much cyclosporine is in it if you get a chance.
I kept the plugs as nobody told me to get rid of them. I will however bring this up at my next appointment.
How long have you been suffering? What eye doctor did you see in London?

[tess77]

I have been suffering from ocular rosacea for more than 10 years but it was after medication of low dose Accutane my eyes got totally destroyed. Have tried everything it seems but with rosacea itīs difficult cause normal treatments seem to irritate and worsen the condition instead of helping

Ikervis is double the dose of cyclosporine than Restasis but used once a day instead of twice. I visit Dry Eye center and Caroline Hodd in London (I live in Sweden) and she said Ikervis is the only cyclosporine drop in the UK right now. Have also read you shouldīt have plugs in while on it but am not sure why.

Find it difficult to continue with something that first makes it worse...how did you react to the steroids and the Restasis? Tried one drop of prednisolone steroid today and got a facial flush straight away...does anyone know if itīs safe to stop steroids after one drop or do you always need to continue and taper them down not to have a rebound effect?

[Angela810]

Hi Nori,

I feel your pain. I saw over 9 doctors in the UK over 2.5 yrs, to try to get help after Lasik. In the meanwhile my condition was worsening. I went on a roller coster ride of steroids, eye drops, warm compresses, doxy, and more steroids. Finally optimmune calmed down the inflammation. I only had my lowers plugged since there is a possibility of increasing the inflammation if both are plugged.

I begged for serum or plasma in the UK and didn't get it. Finally I went to Spain, Vissum, there and back in 1 day and got plasma. It's relatively cheap compared to how much you would need to pay if you wanted plasma in the UK privately. I really just wish I had gone there sooner. The UK is the worst place on the planet to have dry eye or lasik issues because there is no help at all!

Plasma really helps improve dryness. Here's some hope for you:


http://www.ncbi.nlm.nih.gov/pubmed/19965821

[Angela810]

Ooh forgot to add:

Try to increase the humidity in your flat. I bought a tiny humidifier which didn't help much.

Try placing wet towels on the radiator - that will increase humidity.

The trouble with Lasik is that it ruins the quality of the tear. So there is less oil in tears after lasik, in some people. I am definitely one of those people. Apparently that's because the feedback loop is disrupted. Im not sure if the oil production can increase with time as the nerves grow.

We'll have to see...

[nori2015]

Hi Nori,

I feel your pain. I saw over 9 doctors in the UK over 2.5 yrs, to try to get help after Lasik. In the meanwhile my condition was worsening. I went on a roller coster ride of steroids, eye drops, warm compresses, doxy, and more steroids. Finally optimmune calmed down the inflammation. I only had my lowers plugged since there is a possibility of increasing the inflammation if both are plugged.

I begged for serum or plasma in the UK and didn't get it. Finally I went to Spain, Vissum, there and back in 1 day and got plasma. It's relatively cheap compared to how much you would need to pay if you wanted plasma in the UK privately. I really just wish I had gone there sooner. The UK is the worst place on the planet to have dry eye or lasik issues because there is no help at all!

Plasma really helps improve dryness. Here's some hope for you:


http://www.ncbi.nlm.nih.gov/pubmed/19965821

Hi Angela, I've seen in a previous post You had your lasik flap lifted, do you think that's what helped most?

[nori2015]

Two weeks in to my steroid regime and no improvement in redness.
Will this ever go away?