Unbearable dry eyes

[MGD1701]

Blephacure the eye dr mask is similiar to Bruder's. You can do a bit research and compare.
Both keep the heat longer (and safer) compare to Thera Pearl (made in China), in my view.
Perhaps consult with nurses/doctor when you visit them on Friday.
Just show them the Thera Pearl and see what they say.

[WVM]

Hey,

The appointment didn't help a lot. We decided to stop the Ciclosporine treatment. I will finish the remaining dose I still have.

Doc wasn't convinced by IPL treatment and he recommended me to not spend the +- €600 investment on it that it will require. (the treatment is not covered by insurance here). He also didn't believe that expression would help me so it looks like that is off the table unfortunately. I will try to get a second opinion though.

I was afraid of this but he wants to put me back on Doxy (capsules MGA 40 MG) as a chronical treatment this time. It was the only medicine that helped me during the last 2+ years. I'm skeptical though and will need to talk with my dermatologist first, as doxy will also affect my skin care treatment for atopic eczema (light therapy). I'm getting blood tests done tomorrow to check my liver.

I am also getting my scleral lenses this Friday.

Strangely enough my eyes have been near perfect these last three days again. I wish I could figure out what it is exactly that's improving my condition, because I did not make any significant changes (besides quitting ciclosporine). I've been using Eye Drops by A. Vogel (extra intensive) but I highly doubt this is what's causing the positive change.

[Hokucat]

Hi WVM. You having another few good eye days in a row is a good sign that things (like your meibomian glands) are still functioning.

I know this sounds like a lot of work, but I would highly recommend keeping a detailed DAILY log. It would include:
-everything you eat and drink at breakfast, lunch, dinner, and in between
-how much water you are drinking and when
-what meds and eye drops you are using and how often
-how many hours using electronic devices
-what exercise you are doing and how long
-how many hours of sleep you are getting
-other notes on what you did that day

This really helped me figure out what made my eyes feel better or worse. For example, on the rare days when my eyes felt better, I would look back at my log to see what I ate the day or two before and try those foods again, usually one at a time for at least a week. This is how I determined lemon with green tea, a juicy slab of salmon, a small cut of steak or prime rib (I limit beef, but my eyes always have more moisture for a few days every time I eat it), berries, drinking water before going to bed and first thing in morning, and including parsley in my daily juicing all helped my eyes feel better. And I found when I had too much sugar or gluten, my eyes felt terrible the next day. It is a tedious process, but being methodical like this was key to my recovery, when doctors and numerous treatments could not help me for many years.

I'm glad you are getting sclerals this week. Even if the dryness gets better, seems more and more research is finding long term regular hard or soft contact use can cause dry eyes and other cornea diseases, so sclerals are better since they vault over and protect the cornea with saline. Hope it goes well!

[PG]

WVM, instead of relying on the opinion of one doctor regarding IPL and expression, go on PubMed and research it yourself. Maybe the opinion is based on your diagnosis or your improvement? IPL is for MGD (not tear deficiency) and works best for MGD with ocular rosacea.

[waterbee]

if your having allergies have you thought of having allergies shots / low dose imno therapy? you can get this for almost any allergie (im having it right now for red peppers for instance, which is random but something my eyes always got worse with), so if you know what your reacting to that would be a really good direction to go down, there are those that have great success with eliminating allergies this way. perhaps it wll also improve your dry eyes in time too?

[WVM]

if your having allergies have you thought of having allergies shots / low dose imno therapy? you can get this for almost any allergie (im having it right now for red peppers for instance, which is random but something my eyes always got worse with), so if you know what your reacting to that would be a really good direction to go down, there are those that have great success with eliminating allergies this way. perhaps it wll also improve your dry eyes in time too?

I did imno therapy for one year 3 years ago but quit when I moved to go and study in another city. Perhaps it's good to check that out again indeed, but right now I'm already going to the hospital twice a week for light therapy (eczema) and can't really combine more visits with my full-time job.

So I got my sclerals today. They felt good and sight was OK, but I was unable to get them in and out . It's really difficult. I'm feeling discouraged but I have to go back on Thursday to try again. Let's hope I'm more successful that time. Any tips?

Doxycycline is on hold because it can't be combined with my light therapy (doxy makes you more sensitive to light) & the doctors don't want me mixing treatments.


Sigh....

[Hokucat]

Glad the sclerals felt good on. It's perfectly normal to take awhile to get used to inserting and removing the lenses, we've all been through it. Rebecca just sent out some tips that includes inserting and removing sclerals in her April 13th KeratoScoop e-mail for new users. Maybe worthwhile to take a look. Also might be helpful for your doctor to watch how you remove and insert them several more times to tell you what you should do differently. A few things I personally had to remember to do when I was learning was:

-holding open my upper and lower lids a lot for both inserting and removing
-when inserting, looking directly at the center of the lens and ensuring the lens was parallel to my eyeball when approaching with the lens on the plunger, versus tilted at an angle.
-putting several drops of preservative free saline in my eyes and on the plunger before removing. The lenses were less apt to stick to my eye and will gave the plunger more suction.

Hope this helps!

[waterbee]

im not a doctor but i believe there is another antibiotic that was been proven to help with MDG too (i remember from reading about lyme i ended up reading up on every antibiotic on the planet but as a bonus got an insight to studies on how some abx effect dry eye as i went along. I think its azithromycin, might be worth asking about

[WVM]

Yay! I got my scleral lenses today. Removing them on my own for the first time in 15 minutes. A bit scared but will have to do it. They seem to helping so far (no eye irritation / tearing for the first time in months). There's just one thing, after one hour they seem to be 'fogging up' a bit after winking. A bit like car windows in winter. Is that normal? Maybe its the fluid evaporating?

Curious to hear from other scleral lens wearers which other treatments you're still applying? I guess I should keep on doing the following:

- warm compresses, massage and cleaning lids in the morning / evening
- use of artificial tears with and without scleral lenses

Anything else? I'm not sure if my punctal plugs are still in my eyes (I think yes, for 4+ months already surprisingly). Should I ask for new ones once they fall out?

Fingers crossed!

[Hokucat]

Congratulations on getting your sclerals and removing them yourself! Eventually you will be able to remove them in seconds.

It's common for lenses to fog up on the inside. That may go away with a fit adjustment, But if not, sometimes what helps is before inserting, putting in a couple drops of your favorite preservative-free artificial tears and rolling it around inside the entire lens to coat it, before filling with saline. It also can help with the comfort. Seems like it makes a better seal and cushion than saline alone. I've read several people use Refresh Celluvisc, I find Genteal Tears (formerly called Tears Naturelle Free) soothing. Using drops in the lens was recommended by my Boston PROSE scleral doctor.

If the outside of your lenses get smudged or dirty while wearing them, try wetting a Q-tip swab in Boston Condioning Solution or preservative-free saline, and lightly clean the lens with the wet Q-tip without removing your lenses. This was also recommended by my PROSE doctor.

If your eyes start to feel uncomfortable or dry, like you said, you can use preservative-free artificial tears over your sclerals while wearing them. The method that works for me is lifting my upper eyelids and putting a few drops above the lens edge on the white sclera, doing the same under my lower lids below the lens edge, and blinking several times so that it spreads over my entire eyeball. I think this provides comfort because the drops get in between the lens edge and sclera, forming a nice cushion.

If all else fails, some people take off the lenses, clean them, and reinsert, but that's not always convenient. Either way, check with your doctor on all the above first.

Yes, good to keep doing all the other things you're planning to do. Probably good to also do hourly blink exercises to help keep the oils flowing. There's been debate recently on whether eyelid massage is harmful, so perhaps look into that. If your dryness/MGD starts to get worse, you may have to revisit IPL, expression, probing, diet. etc. otherwise you might not be able to wear your sclerals at some point...that's what happened to me for several years. So keep looking for what caused your condition, to determine the best treatment(s).

You should be able to see your plugs. They can stay in a long time, mines have been in for several years. If you found they fell out, it probably won't hurt to have them replaced.

Ok, sounds like you're on a good track now managing your symptoms with the sclerals! Hope it goes well.

[WVM]

Thanks so much for the tips. My doctor tells me I should take out my sclerals every four hours and re-fill them. Do you do this as well? It's a lot of hassle obviously.

[Hokucat]

You're welcome, glad to help! When my eyes used to be very dry, I used to take my lenses out, clean them, and refill them like your doctor suggests, usually a few times per day. It does help, but yes it's a hassle, especially if not at home. Sometimes in a pinch, using several drops of preservative free saline over your lenses can help temporarily.

Now that I'm much better and can manage my condition, I wear my sclerals for 12+ hours straight with no issues, so hopefully at some point once you get better, you can too.

[WVM]

Can I ask you how you got better?

The next step according to my doctors if the sclerals don't work is either oral doxy or oral ciclosporine, which obviously both have very nasty side effects..

[Hokucat]

Of course. The main things that helped me get well was first clearing the blockage and scar tissue in my meibomian glands with the probing procedure, and then drinking fresh lemon juice in strong green tea 2x daily...somehow the lemon/tea was what my body needed for the meibum to continuously flow (my oil was thick like Crisco oil, so kept blocking up the glands). For you it may be something else. Sometimes it's something simple that makes the difference, but it's finding what that is that's difficult.

It took me five probe procedures over two and a half years to discover lemon/tea worked for me. After each probe, I would make some diet changes in hopes that it would help. I kept a daily log of everything I ate and drank for breakfast, lunch, dinner and in between, and also how my eyes felt that day, medications and eye drops used, and other activities like hours of electronic devices, exercise, sleep, etc. it was tedious, but that's how I methodically found what made my eyes better and worse.

Below is a recent post where I listed the main factors that helped me recover and manage my condition, and also the original post of my journey where I ultimately decided to make diet changes:

http://www.dryeyezone.com/talk/forum...ccumulate-info

http://www.dryeyezone.com/talk/forum...evere-dry-eyes

Your sclerals might be just part of the solution. And even if for some reason you cannot wear them now or very long comfortably, that can change as you find other ways to manage your symptoms and get better.

[MGD1701]

Hi
I also keep a daily (as detail as possible) to help me figure out what are good/bad for me and it helps.