this doctor's visit seemed a little weird...

[blinky]

I've been suffering from what I would call moderate to severe dry eyes for over 2 years now. I wouldn't even dream of wearing eye makeup or contacts and I have to wake up during the night to add even more gel in to my eyes. I'm in either constant discomfort or pain from this condition and use eye drops, hot washclothes cold wash cloths, you name, and wash my eyes constantly. I've been to an opthamologist about one and a half years ago who put me on two weeks of steroid drops and then restasus for year, which brought things down from severe to moderate to severe. I decided to see a second doctor this year who specializes more in dry eyes. I chose a local optometrist who focuses the majority of his practice on dry eye patients. in fact most of his website discusses dry eyes and he's even published articles about it. well I went with high hopes and left to the feeling that something to be very very off.

He examined my eyes under a slit lamp and then put the pink stain in my eyes and then the green stain in my eyes. He seemed to be taking his time in answering a lot of my questions and explaining everything s but what he said next surprised me. he said that I had mild dry eyes and he saw no damage on my cornea although I have to pry my eyes open every morning by pouring eyedrops in them before I even open my eyes. I was shocked but happy and relieved that he said I had mild dry eyes; he even discussed patients like me who have severe symptoms and pain yet really symptomatically only have mild dry eyes. he said I did not have any plugged or oil ducts and that I only had a tear deficiency. I asked him how he can be so sure about that and he said experience.

So here is the part that I thought was strange... he then proceeded to prescribe 3 weeks of lotemax eyedrops, 3 times a day for one week, 2 times a day for the second week, and one time a day for the third week. then he wants me to start using alrex eyedrops for the next two months one drop a day. That's some form of steroid drop for 3 months. Oh and he wants me to start using restasis again immediately, but he said he wants me to use it 6 times a day instead of twice a day. is it is strange? He says I have mild dry eyes with mild inflammation yet such an aggressive regimen? does this seem strange to anyone else? He also seemed 100 percent sure that I do not have any kind of oil gland disorder, is that possible when my eyelids itch and how I get globs of stuff on my eyelashes all the time? I walked away from the appointment relieved that I had no corneal abrasions but shocked that there seem to be so many contradictions in what he said. please give me your opinion on what I should do next...thank you so much!

[No tears in ATL]

I want to say there was a study one of the members put up here that showed that cyclosporine (restasis) was more effective with higher dosage. Hopefully I did not dream that. Maybe that is what your doc is looking at. As far as the steroid drops, I think there are some who have been on steroid drops safely for longer periods as long as they do not have raised IOP.

As far as the contradictions, I've had that too. I had one look at my tear breakup time and say "you don't have dry eyes" when my eyes were clearly red and inflamed and had noticeably reduced tear film. Then another told me I had mild bleph plus AD. Another said my oils were starting to get thick but no AD. It is frustrating. I am glad that this doctor is taking time with you, though--that is a good sign. Maybe others here have some more input.

[NotADryEye]

You can always get a second opinion. You might try an ophthalmologist who is a corneal specialist.

[blinky]

I just wanted to get your guys opinion on whether I needed a second opinion because my insurance won't pay for it so it has to come out of my pocket. so please let me know what you think about his ideas and if you think I should get a second opinion.

[Rebecca Petris]

I think everything you've described seems plausible. As with everything, your choice at the end of the day as to how comfortable you are with it. Many specialists are very aggressive with steroids before Restasis, and yes, there is some evidence for higher dosages of Restasis (we have members here who have benefitted from high dosage OR higher concentration, compounded) - plus if Restasis improved things somewhat, maybe more will do more - so it's not like these are unreasonable things to try. Doctors are going to vary a lot in whether they prescribe exclusively based on your clinical signs (mild, apparently) or in response to the severity of your symptoms & how much you're affected by them.

At the same time, clearly there are questions left unanswered. Did he give any explanation for your eyelid issues? And for the severity of your symptoms in the early AM? If not, can you call or email and get a clarification. Nocturnal lagophthalmos, blepharitis, etc are often a part of that kind of pattern.

As to seeing no damage on your cornea despite what you go through in the early AM: Anybody this happens to should try really hard to get the very first appointment of the day when the see the doc. Some people go through h*ll in the morning but the epithelium repairs itself so fast that there's nothing left to see by the time their appointment rolls around.

I guess I'm saying, I'd try to get more information from this doctor before pursuing another if you have to pay out of pocket.

[NotADryEye]

He also seemed 100 percent sure that I do not have any kind of oil gland disorder, is that possible when my eyelids itch and how I get globs of stuff on my eyelashes all the time?

As per my doctor, itching is usually a sign of allergies. The "globs of stuff" could also be from the allergies or something else e.g. demodex mites, bacterial infection, or something else.

Can you describe the "globs of stuff" very specifically, how it looks, when it happens, when you find it, etc.