What is the natural progression for someone with Dry Eye

[jack1988]

2Hi guys,

Over the past couple of months, my dry eye has gotten worse. The doctors, last time i went to see them, gave me Hylo-Forte. That helps a little bit, but my eyes are still sore, inflamed, and when i finish work and go outside they often stream with tears.

I am lucky i guess, bcos when i wake up in the morning, that is my most comfortable. I can open my eye no problem. But, after 12pm my eyes start to sting, and they go red. The Hylo-Forte takes the edge off, but that's about all it does.

So, my question is, what is the usual progression in terms of medication? I presume it is something like this

1) Artificial Tears/lubricant in the first instance.
2) Then Steriods / Immune depressive eye drops if Artificial Tears don't work
3) Plug the tears ducts

Am I along the right lines?


--------------------------------------------------------------
My routine

Hylo-Forte x3 daily
Omega 3,6 & 9 4 capsules daily

[Guest]

This is such a hard question to answer...do you have A diagnosis on what type of dry eye you have? For example, I have evaporative dry eye caused by MGD. My meibomium glands produce a foamy type of meibum...it's like getting soap in your eyes. Do you have an autoimmune disease? I could keep going but my point is that it's hard to say.

I injured my eyes, conrbeal abrasions and it set off the worst pain I've ever felt in my life. I couldn't find relief then finally, for me, it was lid hygiene, hot compress, restasis and a light steroid called alrex. I just got my autologous serum drops today and just started those. I feel way better, id say I have my life back, plus slight inflamed eyes. But I can function, I can laugh again, life is better. Could it get worse, yes and it most likely will. So I would personally be as aggressive as possible when treating your disease. I just tried doxycycline also, got the stomach flu, thought it was the doxy and stopped. But I'm going to start back on that once I feel my gut is back to 100%. Why? Bevause my doctor said the best way to control the MGD from the inside out is with an antibiotic.

Id say go see more doctors, get a solid diagnosis, and don't wait...so it now.

[jack1988]

This is such a hard question to answer...do you have A diagnosis on what type of dry eye you have? For example, I have evaporative dry eye caused by MGD. My meibomium glands produce a foamy type of meibum...it's like getting soap in your eyes. Do you have an autoimmune disease? I could keep going but my point is that it's hard to say.

I injured my eyes, conrbeal abrasions and it set off the worst pain I've ever felt in my life. I couldn't find relief then finally, for me, it was lid hygiene, hot compress, restasis and a light steroid called alrex. I just got my autologous serum drops today and just started those. I feel way better, id say I have my life back, plus slight inflamed eyes. But I can function, I can laugh again, life is better. Could it get worse, yes and it most likely will. So I would personally be as aggressive as possible when treating your disease. I just tried doxycycline also, got the stomach flu, thought it was the doxy and stopped. But I'm going to start back on that once I feel my gut is back to 100%. Why? Bevause my doctor said the best way to control the MGD from the inside out is with an antibiotic.

Id say go see more doctors, get a solid diagnosis, and don't wait...so it now.

thanks for the reply,

the doc told me my eye surface wasn't that bad at all and gave me hylo-forte. Do/did you have bleph?

My doc says i don't have bleph either, so weird!

[Guest]

Yes, I have mild blepharitis caused by an overgrowth of bacteria in my meibomium glands. That threw off the PH and consistency of my meibum and caused most of my issues. You need someone to express your glands under the slit lamp and id also get a meibeview if the expression is odd. that way you can see if the glands are functioning. Almost all dry eye is related to MGD, very few are legit aqueous deficiency. So my gut is telling me you may have some bad glands or lack of expression, thick meibum, something thats causing this reflex tearing....because it sounds like evaporative dry eye. You may produce too much oil, thats can cause this issue as well.

What made you go into the doctor? did you all of a sudden get this tearing or have you had issues for a while? was there an event that set things off in a bad way?

[jack1988]

Yes, I have mild blepharitis caused by an overgrowth of bacteria in my meibomium glands. That threw off the PH and consistency of my meibum and caused most of my issues. You need someone to express your glands under the slit lamp and id also get a meibeview if the expression is odd. that way you can see if the glands are functioning. Almost all dry eye is related to MGD, very few are legit aqueous deficiency. So my gut is telling me you may have some bad glands or lack of expression, thick meibum, something thats causing this reflex tearing....because it sounds like evaporative dry eye. You may produce too much oil, thats can cause this issue as well.

What made you go into the doctor? did you all of a sudden get this tearing or have you had issues for a while? was there an event that set things off in a bad way?

I had squint surgery on my right eye a few years ago, and since then I have noticed that it is dry when I wake up sometimes, then over the past few months I have noticed after 12pm it starts getting really sore and red. My right eye is worse than my left in terms of dryness. Hylo-forte takes the edge off but that's about it

[mbperso]

Yes, I have mild blepharitis caused by an overgrowth of bacteria in my meibomium glands.

How did you find out that you the issue was caused by bacteria ?

[Guest]

How did you find out that you the issue was caused by bacteria ?

When he expressed the meibum he said and I quote, "you have a foamy meibum which suggests the ph is off due to lipase activity caused by bacteria". That's why he wanted me on doxy, to get inside the infection...he said doxy or a systemic antibiotic is the only way to treat MGD from the inside. You can compress, lipiflow, whatever you want but it's just superficial.

[Guest]

I had squint surgery on my right eye a few years ago, and since then I have noticed that it is dry when I wake up sometimes, then over the past few months I have noticed after 12pm it starts getting really sore and red. My right eye is worse than my left in terms of dryness. Hylo-forte takes the edge off but that's about it

I'm telling you, we need more information here. So yu had a surgery that seems to have set off some dry eye issues, but again, why? Did the surgery make it to where you don't fully blink now so you're not expressing oil? Do you have an aqueous deficiency that just came apparent recently due to surgery?

The only way to know how to treat your problem is to see what's going on with your eye. That's why they call it a multifactorial disease...every person has different factors contributing to their dryness. I'm curious what yours are.

have you seen a doctor that's expressed your glands or done fluorescence staining to see what's going on? Until you do that you'll have no idea how to fix this.

[jack1988]

I'm telling you, we need more information here. So yu had a surgery that seems to have set off some dry eye issues, but again, why? Did the surgery make it to where you don't fully blink now so you're not expressing oil? Do you have an aqueous deficiency that just came apparent recently due to surgery?

The only way to know how to treat your problem is to see what's going on with your eye. That's why they call it a multifactorial disease...every person has different factors contributing to their dryness. I'm curious what yours are.

have you seen a doctor that's expressed your glands or done fluorescence staining to see what's going on? Until you do that you'll have no idea how to fix this.

They have done the staining with the yellow liquid and told me my eye surface is fine. I have had bleph in the past, but my hygiene has been good so the inflammation is gone. I am seeing a specialist on Monday, so i will report back then

[Guest]

They have done the staining with the yellow liquid and told me my eye surface is fine. I have had bleph in the past, but my hygiene has been good so the inflammation is gone. I am seeing a specialist on Monday, so i will report back then

Ask him to express you glands to see if there's blockage and what is the consistency of the meibum if any. Curious to hear what they say. Good luck, I think you'll get this sorted out after this visit assuming the doc knows their shit.

[jack1988]

Ask him to express you glands to see if there's blockage and what is the consistency of the meibum if any. Curious to hear what they say. Good luck, I think you'll get this sorted out after this visit assuming the doc knows their shit.

Thanks

I would like to speak to someone on here who is from the UK, to see if they can recommend a specialist. Do you know of any users that are from UK? I tried using search function but to no avail

[jack1988]

Went to London today to see a specialist. He said my bottom glands on my right eye are blocked, and told me to warm compress and then express the glands. He also said there is a little bit of inflammation, and prescribed me Doxy tablets x1 daily, and FML eye drops 4x daily for 2 weeks, and then 2 times daily for 2 weeks.

How long after I put in the FML drops can I put my lubricator drops in? Forgot to ask the doctor that question!

[Guest]

Went to London today to see a specialist. He said my bottom glands on my right eye are blocked, and told me to warm compress and then express the glands. He also said there is a little bit of inflammation, and prescribed me Doxy tablets x1 daily, and FML eye drops 4x daily for 2 weeks, and then 2 times daily for 2 weeks.

How long after I put in the FML drops can I put my lubricator drops in? Forgot to ask the doctor that question!

I'd wait about 15 minutes or so to let that medicine have time to absorb. I wait 15 minutes between my steroid and restasis...seems to work well for me.

Its important your compress isn't too hot or too cold...I use a laser thermometer to check the temp on my compress pad. It usually sits around 111-112F optimum is 104F...so I let them cool a bit then apply it until it's no longer warm 5-8 minutes usually. Now the key for me was expression after ward then cleaning my lids. So make sure you massage those lids nice and good after that heat. Again make sure you don't go too hot on the compress, I hear it can warp the cornea. Did the doctor mention a lid scrub like a hypochlorous acid spray? I think that's essential, once you express that shitty oil, you want to wipe away all of that discharge to keep the bacterial load down and just to keep everything clean. Glad you're getting some answers, makes tons of sense now why you're reflex tearing. You need oil like the tin man lol. So do I, so I get it.

[jack1988]

I'd wait about 15 minutes or so to let that medicine have time to absorb. I wait 15 minutes between my steroid and restasis...seems to work well for me.

Its important your compress isn't too hot or too cold...I use a laser thermometer to check the temp on my compress pad. It usually sits around 111-112F optimum is 104F...so I let them cool a bit then apply it until it's no longer warm 5-8 minutes usually. Now the key for me was expression after ward then cleaning my lids. So make sure you massage those lids nice and good after that heat. Again make sure you don't go too hot on the compress, I hear it can warp the cornea. Did the doctor mention a lid scrub like a hypochlorous acid spray? I think that's essential, once you express that shitty oil, you want to wipe away all of that discharge to keep the bacterial load down and just to keep everything clean. Glad you're getting some answers, makes tons of sense now why you're reflex tearing. You need oil like the tin man lol. So do I, so I get it.

No, weirdly, he never mentioned any wipes. He said, use warm compress and then massage the lower lids.

Hmm...I will make sure it is not too hot then. How often do I have to use warm compress? The strange thing is, I don't have any crustiness or anything, and to the untrained eye my eyelids look 'normal'

[Guest]

No, weirdly, he never mentioned any wipes. He said, use warm compress and then massage the lower lids.

Hmm...I will make sure it is not too hot then. How often do I have to use warm compress? The strange thing is, I don't have any crustiness or anything, and to the untrained eye my eyelids look 'normal'

I'm the same way, no crust, if you looked maybe just a tad pink on my margins but I would look "normal" also. The bacteria is inside the gland and the lipid byproducts inside the gland causes the oils to thicken. So you use a hot compress, twice a day, then clean the eyelids directly afterward. They should sell Alcon eye scrubs in the U.K. try amazon. Get a good lid cleaner in the meantime, then get a prescription for hypochlorous acid spray. Here in the states we need a script for something like avenova which is a hypochlorous acid spray. It kills the bacteria around the eyelid. It's usually our own staph that's naturally in our skin that tends to over grow inside the meibomium gland. So the idea is if you clear the glands then clean all the bacteria off the lids. You reduce that bacterial lipase avtivity in the gland and the oils should run easier and more clearly. Good thing he put you on the doxy. One of the best treatments for MGD, I just recently started doxy and got a stomach flu so had to stop. But once my gut is good I'm going to give it a try again.

I think youre om a good path, once you get a hypochlorous acid spray and get a good heat mask online that you can toss in the microwave and really massage those lids. You will feel a lot better in a couple months. Let me also suggest you take a high quality omega 3 I use Nordic naturals ultimate omega liquid. But any high quality omega 3 fish oil in triglyceride form would be great. The idea with the fish oil, is that once you clear the garbage out, you want to replace it with good quality oil. So a healthy diet, a good multivitamin and a good fish oil supplement will do wonders to get that oil in good shape again. You could also get a blood panel andcheck your hormones. Hormone replacement would help as well asssuming your androgen deficient.

Good luck!