Tear production/ schirmer scores getting worse

[Matt0029]

When I first went for a dry eye assessment I had a schirmer score of 4mm left and 9mm right in July this year. When I got lower plugs fitted in august I was 3mm left 8mm right. A month after lower plugs I was 2.5mm left and 8mm right. Now in November I am 2mm left and 3mm right eye. Any one else had some thing similar. Will it likely get worse till it gets to zero? I am off back Monday to see an opthalmologist to maybe get upper plugs.

[Matt0029]

Going to ask about ikervis (ciclosporin) drops. The optometrist said she can see no inflammation on my eyes surface though so it may not be beneficial. Is ciclosporin not usually prescribed if there is no inflammation on the eye? I do know this is the only drop/treatment that may improve my tear production though, I think that is the case anyway. Thanks for any insight in to this.

[Hokucat]

Hi Matt. Both my TBUT and Schirmers reached virtually zero even after I got lower plugs, so that scenario is possible, but that does not mean it will happen to you. And if it does happen, it's not necessarily permanent, but may take patience and time to find the solutions that help you get better.

I may have mentioned this to you already, but I likely had severe dry eye primarily from Sjogren's Syndrome, and secondarily from excessive use of computers and a long drive to work (which reduced my blinking and/or caused partial blinking), and possibly long term regular contact lens use.

I recall you are still early in the treatment process, but have you been tested for Sjogrens, vitamin deficiencies, allergies, food intolerances, etc. yet? Do you regularly spend several hours a day on electronic devices? If the cause of your dry eyes can be determined, treatments, diet, etc. can also be identified to address the root cause(s), not just the symptoms.

I think you're right to try adding upper plugs and iKervis next. I never was quadra plugged, but it has helped some others in this forum. I too was prescribed Restasis even though I had no visible inflammation, but it did not help me, however it has helped others. So everyone's situation can be different on what works.

Ultimately probing unblocked my glands, then diet changes helped my meibum flow and likely increased my tears. My doctors confirmed I have some tear film now, and my eyes feel so much better. But I still have some remaining dry eye because some of my glands were lost/atrophied, so to help manage the remaining dryness I wear scleral lenses, and sometimes take Evoxac (generic name Cevimeline) which is an oral rx pill that helps gives the eyes moisture...not everyone can tolerate sclerals and Evoxac, but if one can, these can provide some immediate relief.

So there is still a lot to try, even more things than I mentioned above. Hopefully adding the upper plugs and iKervis gives you some relief. If the plugs cause your eyes to water too much, see if they can use flow control plugs that have a small hole which allows some drainage. In parallel, it may be helpful to also start seeing specialists (rheumatologist, allergist, naturopath, etc) and getting tested to try to identify the root cause and address that.

[Matt0029]

Thanks I have been tested for sjogrens this came back negative I have had a full blood count test too. I think they have done blood tests for every thing. But I will go back to my gp to see if there is any more tests to do and mention my tear production is getting worse and worse. Though my schirmers score is so low my tear break up time is high above 10. I think my glands and oils are pretty good. My problem is the tear production. I see the ophthalmologist on Monday

[Hokucat]

Oh, that's right, thanks for reminding me you have a good TBUT....that's good. Possibly changing your diet and/or adding supplements may help your lacrimal glands. Have you researched this or seen a naturopath? There's several success stories on diet/supplements and other potential treatment for lacrimal glands in this forum, perhaps something here might help you.

Did you have your GP or a rheumatologist test you for Sjogren's? Reason I ask is the rheumatologist usually takes much more extensive tests for Sjogrens and other autoimmune diseases (that can also cause dry eyes), than the GP.

[Matt0029]

Thanks it was just my gp I will ask him if there is any further testing we can do for it. I will look in to naturopath not heard if that before? Upper plugs may help but may. reduce my tear production even more would you think? I will maybe look in to seeing a lacrimal gland specialist if such thing exists. I have changed my diet to being a lot more healthy. Eat a lot of omega 3s etc.

[farmgirl]

Never heard of a lacrimal gland specialist. I too have Sjogrens but all of my blood work was negative as it often is. I was diagnosed with a lip biopsy. Upper plugs should not reduce your tear production any more I wouldn't think. You might put that question to the doc that installs them if you do get them.

[PhoenixEyes]

I think any ophthalmologist can check the lacrimal gland by inverting eyelids and asking you to look in a certain direction. My cornea specialist ophthalmologist did that and was able to tell me that they are unfortunately scarred due to the condition I had (Toxic Epidermal Necrolysis), I don't get regular schirmer but last I knew it was 0 one eye and less than 3 the other.

[Matt0029]

Thanks I will ask if he can check what the gland looks like if it is scarred or inflamed.

[Matt0029]

Some days my symptoms can be not so noticeable. Be the symptoms always seem to return.

[Matt0029]

Dissolvable or silicone plugs in my uppers will be my next dilemma, I will see what the surgeon suggest.

[Matt0029]

I think my next step will be back to my gp to ask if I have had all the blood tests for reduced tear production and to inquire about a referral to see an ophthalmologist. I would pay private for this if needs be/

[Matt0029]

Any advice on what blood tests to ask for reduced tear production? I have been tested for sjogren's syndrome and I think full blood count and liver function before. The optician mentioned an over or under acting thyroid could cause reduced tear production so I will ask for this to be tested.