Unbearable dry eyes

[ltree]

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.

I am also learning to wear my new scleral lens. This sounds like good tips to help with the dryness and irritation, when I am trying to wear them 12 hours straight for work every day. My eyes get itchy and red, and I think it also has to do with that the current lens are not yet a good fit as well.

[WVM]

I wore my sclerals for 8 hours yesterday and felt pretty good! This is by far the most promising 'solution' yet. Although I also think a better fit might still be possible, seeing the specialist on Friday again. So far, so good!

[Hokucat]

That's great, I'm so happy for you!

Yes, be picky about the fit. I've read sometimes larger lenses are more confortable, mines are 18mm. If you get fitted for another pair of lenses, hopefully they will let you keep this pair as a back up, in case you damage one of your lenses in the future.

[WVM]

Went to my doc today and he was impressed with the (current) healthy condition of my eyes. The sclerals are working great, even after only wearing them for five days now. Yesterday I had them in for 10 hours (including 2 hours spent in cinema which is usually horrific conditions for me), and no complaints! I'm removing them once or twice a day to refill them with the solution. We've put a treatment with doxy in the freezer for now. I'm seeing the contact lense specialist on Friday to double check the fitting of the sclerals. Finally this is going somewhere!

[MGD1701]

Hi WVM, thanks for sharing great news! Could you tell me

1) brand name for such sclerals lens, type (half ?), market prices, how long you need to change a new pair?
2) any special qualitifcations to wear such lens?
3) does it mean with such lens, you dont need to do warm compress, no need drops etc??

strangely, none of 10 doctors ever mentioned it to me. Maybe they have no clue too?? Thanks!

[Hokucat]

Hi WVM,

It's so inspiring to hear how quickly you've adjusted to sclerals, and that they are helping the surface of your eyes. Just last month when you initially posted, you were really struggling, now look where you are!

Just don't forget to keep looking for and ultimately treating the cause of your MGD, because if that continues to worsen, at some point you might not be able to wear your sclerals.

Hi MGD1701,

Yes, would think your doctors would have brought it up as an option! Scleral posts are all over this forum, so you can learn alot here and try pursuing yourself, if interested.

Note sclerals help manage symptoms, but do not usually resolve the underlying condition, especially not MGD. However, the ability to quickly feel relief with sclerals like WVM, can be a major step in getting some of your life back.

Sclerals are nickel-sized, dome-shaped rigid gas permeable lenses that vault over the cornea to bathe them with saline, and the lens edges sit on the sclera/white part of the eye. They have become more mainstream in successfully managing dry eyes and other eye problems, while also correcting vision. Usually the main reason you would need to change them is for the vision.

Below is a good description of sclerals in general from Boston PROSE sclerals. I happen to wear PROSE lenses and have been extremely happy with them and my PROSE specialist, but there are other different brands of lenses like Europa/Jupiter, EyePrintPro, etc. What is key in successfully getting fitted is the expertise, experience, and training of the specialist.

http://www.bostonsight.org/PROSE/PRO...y-Eye-Syndrome

A scleral specialist would do a consult first, to see if you are a good candidate. At the consult, you typically try on a trial pair(s) of sclerals for an hour or so to see if you can tolerate them (not everyone can), and if the lenses make your eyes feel better. If you are deemed a good candidate and agree to proceed, there's a fitting process where they order custom lenses you try for a period, ordering new ones if the comfort/fit is not sufficient. Fittings can take several tries. So the costs usually consist of a consult, fitting, and scleral lens fee, if you go all the way. I've heard the total costs of everything ranging from around $2,000 to $10,000, and could be covered by insurance if deemed a medical necessity. Mine was. Often the fitting fee is the largest cost because it can take several tries. For an update due to vision changes, usually you only pay for the exam and cost of the lens, like you would for glasses or regular contacts.

Continuing regimens like warm compresses, drops, etc. are important while using sclerals, but can be specific to the individual and the on-going status of their condition. If you have MGD, likely you would continue compresses or whatever works to help your oils flow, otherwise glands can get further blocked, atrophy, and things like your sclera the lens sits on may get too dry to wear the sclerals anymore. Many continue using artificial tears for added comfort over their sclerals while wearing them and when not. However, since sclerals bathe your corneas in saline the entire time wearing them, some no longer need drops while they have the lenses on. Also, if the lenses help heal their cornea, they may also not use drops as often when not wearing lenses.

I no longer need warm compresses or drops, mainly due to the combination of 1)addressing my root cause with first unblocking my glands with probing and then maintaining the oil flow with the lemon/green tea (that works for me), AND 2)managing the moderate remaining dryness due atrophy of some glands by using sclerals 12+ hours a day. So often sclerals is not the only solution, but part of a combination of treatments/factors.

The PROSE link above also has their fitting locations. Here is a link Rebecca sent out last month in one of her KeratoScoop emails, which lists resources for scleral fitters, not particular to a specific brand. There are some listed outside the U.S.:

https://www.sclerallens.org/scleral-fitters

[WVM]

Hi WVM, thanks for sharing great news! Could you tell me

1) brand name for such sclerals lens, type (half ?), market prices, how long you need to change a new pair?
2) any special qualitifcations to wear such lens?
3) does it mean with such lens, you dont need to do warm compress, no need drops etc??

strangely, none of 10 doctors ever mentioned it to me. Maybe they have no clue too?? Thanks!

Hi there!

No problem, I'll definitely stick around on this forum to share my experience with this horrible disease. Hopefully I'll be able to help some people with the things I've learned. To answer your questions:

1. I'm not sure about the brand. I'll ask on Friday when I see the doctor again. They were prescribed to me in the hospital and they handled everything for me. The price here is €1150 EUR for one lense, but the insurance covers it completely (I'm from The Nertherlands). I've heard - if I maintain them properly - that my sclerals could last for 2 years, after which a new pair will be covered by the insurance again.

2. Not as far as I know. They feel like very high quality materials and are highly tolerable. They can also easily correct my astigmatism. I can see very clearly through the lense. It just takes a lot of practice to put them in and remove them because they're huge! I wear 18.5 mm sized sclerals. But I got the hang of it after a few days.

3. I still do warm compress and drops in the morning because I still have a lot of pain when I wake up. I don't use any drops while wearing the sclerals but I do take them out approximately every four hours to refill them with a neutral solution that hydrates the eye and lense. When I remove my sclerals in the evening, I use drops again, but less than before. Before sleep I still apply Dureatears eye gel.

Hope that answers your questions. Definitely ask your doctor about sclerals lenses!

[MGD1701]

Hi WVM, thanks a lot for the details. Seems Netherlands has great insurance system and eye care service/products. Lucky you!

About your morning pain
It suggests your eye gel is not suitable or lid scrubs problem. Perhaps just add a pair of swimming goggle - it helps me.
Better improve it otherwise might hurt conera. I often had such pain in the past and now seldom.
I use EvoTears (other oil-based drops will do too, I suppose).
One MD suggested here in the forum: wash eyelids with running ''warm/hot water'' (10-20 times) - to get ride of bacteria/dirts etc.
Then better do a bit of massage + lid scrubs too, in my view.

Look fowrward to the brand/model names so I can consult doctor. Thanks!

[PhoenixEyes]

One MD suggested here in the forum: wash eyelids with running warm/hot water (10-20 times) - to get ride of bacteria/dirts etc.
Then better do a bit of massage + lid scrubs too, in my view.

I'd follow this up with a safe moisturizer with antimicrobial properties if possible. I learned from having atopic eczema that every time I washed my hands with water it actually dried my hands out more, apparently though the water washes away the bad stuff like bacteria and dirt etc. it can also wash away the good stuff like essential skin oils. Apparently you can get lid scrubs with tea tree oil in them so could try that if it's moisturizing and antimicrobial. Or a gentle tea tree moisturizer lotion applied to fingertips while doing the massage.

Lid scrubs containing tea tree oil, which eradicates Demodex, are also marketed for the treatment of MGD based on a suggested pathophysiologic role of infestation with these mites. Understanding of the relationship between Demodex and MGD is incomplete and there is a lack of good scientific evidence supporting use of tea tree oil scrubs for MGD treatment alone.

Tea tree oil also has antibacterial, antifungal, and anti-inflammatory properties that may be beneficial, and it has been shown to reduce symptoms of surface inflammation.

http://ophthalmologytimes.modernmedi...till-challenge

[MGD1701]

Good points, PhoenixEyes. so one needs to figure out the suitable temperature and frequency, maybe 5 times will do too??

Dry hands? my dr suggests oil based hand cleanser - pretty good.

Lid scrubs - I recently found a great product - soapfree tea tree oil shampoo, without parfum/conservatives and my eyes are ok with it. Seems helpful too!

eye cream/lotion - my dr says I should keep 1cm distance from eyes, for your info.

[PhoenixEyes]

Dry hands? my dr suggests oil based hand cleanser - pretty good.

Getting a good hand cleanser that puts back what the water takes away does seem essential. I finally found Dermol lotion to be my solution for hand eczema, it's moisturizing and antimicrobial, but must be careful not to get it in the eyes if using it as a face wash, I think it has BAK benzalkonium chloride in it. Everyone is different though so some may not get along with it entirely, I'd tried various topical steroid creams and other moisturizers before this.

Lid scrubs - I recently found a great product - soapfree tea tree oil shampoo, without parfum/conservatives and my eyes are ok with it. Seems helpful too!

I use a tea tree oil shampoo in the shower but I think it has alcohol in it as a preservative so I don't rub it on my eyes. Sounds good that the one you have doesn't use harsh chemicals, does it have a brand name at all?

[MGD1701]

Soap-free Tee Tree Oil Shampoo/Shower Gel, Brand: Bergland, Tee Baum Shampoo & Duschgel.
I have tried many, this is the best. http://www.bergland.de/bergland/prod...productId=4778
They also have facial water with alcohol.

[MGD1701]

Hi WVM,
Just curious - did your dr recommend you do LipiFlow? If not, why?
Does he/she thinks scleral lens are the solution for you then?
Do you know if there are any side-effect from scleral lens? Thanks a lot!

[WVM]

Hi WVM,
Just curious - did your dr recommend you do LipiFlow? If not, why?
Does he/she thinks scleral lens are the solution for you then?
Do you know if there are any side-effect from scleral lens? Thanks a lot!

Hi there,

No, LipiFlow was never discussed. The doctor does not think scleral lenses are the solution for my problem, but they do believe they can reduce the pain and irritation I'm having. I have not encountered any side-effects from sclerals so far.

Scleral lenses are still helping a lot, but today I'm having a lot of trouble with mucus covering the surface of the lense. Very annoying. I've noticed that mucus (I have tons of discharge: clear, long stringy goo) sticks to the scleral lense. This did not happen with my soft contact lenses.

Anyone know an European vendor that sells Theratears nutrition or any alternative? Can't get it shipped to The Netherlands from most websites.

Thanks,
W.

[MGD1701]

Hi WVM, thanks for sharing. Scleral lenses: any ideas about the brand/model etc? Thanks!