Dry Eyes After LASIK

[pacattack81]

Hey,

I'm not sure where to begin, but I had LASIK 2 months ago on April 4th. I've had dry eyes ever since, with my right eye being considerably worse. I've read a lot of this forum over the last couple of months and I understand that this can be quite along process before the dry eyes go away. After the first 2 weeks my vision was excellent so at least I can still see well. I can't thank the people on this board enough for their contributions. They have been very helpful to me over this time.

I decided to seek a 2nd opinion on Friday, May 30th from an eye doctor who's office is part of the Boston Foundation for sight. I've read they've handled many dry eye cases. She did some tests and after looking at my corneas under the slit lamp she said I had dry spots on them and they weren't lubricating well. She said I should wait another month and keep using preservative free eye drops and Genteal at night. She doesn't like restasis and is a big fan of plugs, but she wants to give it more time before we try anything. Interestingly enough with my dry eyes have been a lot better this week. I think it's because of the increase in humidity. Hopefully, it stays like this.

Unfortunately, I am experiencing a new problem. My left eye is a little blurry, not a lot, but enough to be a little distracting. This started right after they placed the filament paper in my eye for the Schirmer test. It burned a lot and I had her take it out. The doctor said the tech's probably didn't use enough numbing drops. I declined taking the test again and she said the test wasn't really important because it's been clear to both of us that I have dry eyes. Strangely enough, she didn't even suggest doing the particular test. It was my idea. Could a simple test like that have irritated my eye and be giving me issues? I can't attribute the change to anything other then the test.

I know it sounds crazy, but the eye has been off ever since the day I saw the new doctor. If i contact my LASIK surgeon, I bet he'll think I'm out of my mind and probably be annoyed I went to see someone else.

Do you guy all have any thoughts on what could be happening? My vision isn't greatly affected, it's more of just an annoying distraction. Sort of like an odd blue. It's very slight, but I notice it and it hasn't been there before. If there was a flap issue there would be a huge loss in vision right? Anyone who's had LASIK ever have the Schirmer test done before? At 2 months was this to soon for me to get a test that places something in my eye? Hopefully it eventually goes away.

Thank you in advance for your response. Sorry for the long post. I hope you're all having a great weekend!

-Jarret

[peter56]

Hi Jarret,
please do read this full text article on post LASIK dry eye and other problems:

http://www.ncbi.nlm.nih.gov/pubmed/22174730 - then click the logo!

LASIK does damage the nerves in the cornea. These nerves are part of the neuronal tear reflex arc, that is
controlling the watery tear production - LASIK caused corneal Innervation etc.
Without a sufficient watery-gel layer of the tear film, the complete tear film systems breaks down.

Almost 50% of the post LASIK patients do suffer dry eye symptoms for up to 6 months.
It is important to apply the best possible therapies right after LASIK!

Getting the Inflammation under control, Restasis drops, Tacrolimus drops from Leiters pharmacy or a steroid
ointment.
Trying to restore the corneal nerve neuronal System in the corneas:
Diquafosol eye drops and Naltrexone eye drops. I think the Naltrexone drops are available from the MEEI in Boston.

Furthermore punctal plugs for up to 6 months and a lot of artif tears-gels and ointment for the nights.

Two studies are claiming, that Omega-3 does promote the healing process of the nerves.
But since the post LASIK watery dryness does also induce a meibomian gland dysfunction, you will have to take
Omega-3 capsules anyway.

Since it is not possible to get a schirmer test every week, you may have to watch your watery tears production.
Are your eyes are moistured all the time or only after stimulation.

[DryInDenver]

I've also got some blurriness in one eye after lasik. I would be surprised if a Shirmer test caused your blurriness.

For me, I always dreaded the many eye exams I had to go to because my eyes were battered afterwards. Keeping my eyes open for each test hurt bad and caused my eyes to get inflamed and painful. It usually took several days for me to get back to my baseline dryness, inflammation, and pain.

Regression to worse vision in lasik is pretty common, especially for dry eye patients. It's one reason the LASIK surgeons often promote "enhancement." For me, the blurriness has come on slowly, but I tend to notice it getting worse in steps. Your eye may have been slowly getting worse and you didn't notice it until after the exam. Particularly if the exam caused some inflammation and dryness like I usually experience, that may have increased the blurriness a bit.

Peter56 is right, baby your eyes to help them heal. I'm 10 months post lasik. After trying darn near every treatment option out there with little to no success, I got some scleral lenses from Dr. Gemoules in Dallas. The lenses keep my corneas soaking in saline solution all day. I think my eyes have healed more in the last month than they did at any point in the previous 9 months combined. The lens also clears up the blurriness in my right eye (which isn't near sightedness like I had before because things are blurry close and at a distance).

I know the last 2 months have probably been tough, but you are still very early in the process - you've got a lot of time to heal. My advice is

• keep your eyes as moist as possible to aid in the healing(consider sclerals if you are still in bad pain at 6 months - even if they only helped me for a month or two but got my eyes to heal completely I would have considered it money well spent)
• stay on top of the mental/psychological part of this disease (often causes more suffering than the dryness and is common among the lasik crowd)
• and keep seeing your doc at BFS - they know more and care more about helping you than most (all) lasik surgeons (who get too defensive of their work and their industry).

Good luck to you.

[kylix]

Hi Peter,
I didn't know Diquash should be able to repair corneal nerves. It's a big pity it's preserved with BAK, otherwise it could be really interesting. Can I please know your opinion on this particular drops and on Rebamipide? Thanks.

[DryInDenver]

Diquash? Are you sure that's not a male hygiene product?

Sorry, the adolescent in me couldn't resist.

[kylix]

sorry, don't know Diquash, it should have been Diquas (Diquafosol eye drops)

[runnergirl]

" My vision isn't greatly affected, it's more of just an annoying distraction. Sort of like an odd blue. It's very slight, but I notice it and it hasn't been there before. If there was a flap issue there would be a huge loss in vision right? Anyone who's had LASIK ever have the Schirmer test done before? At 2 months was this to soon for me to get a test that places something in my eye? Hopefully it eventually goes away. "

Hi,

I had LASIK surgery about 7 years ago. My LASIK doctor put me on restasis right out of the LASIK chair and it helped my dry eye. He said my eyes would be better in 2 months and right at the 2 month mark, I was all better. However, 7 years later .....here I sit with severe dry eye from nothing else but LASIK. Anyway,I was interested in your comment about the blue spot on your eye. I have brown eyes and noticed blue spots that were not there before lasik but were there after. Did you ask the doctor about them? I haven't been back to my doctor in a while, just curious if you found out anything about it. Hope you feel better soon. Just as they said above, baby them for a couple months, they will turn around.

Sue

[Phillips55]

I would get an AMT procedure asap, I would also get a meibography to see how your oil function is. Lasik cuts down on tear secretion but having good oil production greatly offsets that.