This doesn't sound right to me - what do you think?

[DryLondoner]

I had an appointment with my Lasik surgeon, who is "treating" me. It's been 11 months since the procedure.

My symptoms are:

- low schirmers (7mm in left eye, 2mm in right eye)
- red in both eyes, which is slowly getting worse
- eye are stiff, tired, itchy and sting at times
- eyes are uncomfortable and very red on waking
- eyes become red and sore in AC, walking down the street etc
- blinking feels like scraping
- occasional tension behind the eyes, more so just underneath my brow bone
- after about 10am I feel like I need to go back to sleep
- by about 2pm I have to close my eyes every 30 minutes to get through the day
- normal activities, such as cooking, seem uncomfortable, my eyes instinctively want to close themselves
- they feel AMAZING!! after a hot bath or shower

My TBUT is good, about 12 seconds - there is no staining (according to my surgeon drops make no difference to this, he always some in before checking my eyes)

He says I DO NOT have dry eye. And that as long as I have some tears, enough to wet the eyes, I'm fine. He doesn't know why I feel so uncomfortable and attributes it to my eyes having become sensitised from the drops. He says, the only way to determine dry eye is to have either a low TBUT or for him to see staining and the amount of tears is insignificant.

I am using drops minimally, around once a day, mainly because they seem to make me worse and because I'm scared that I am making my eye more sensitive by using them.

Does this sound right? Any insight would be much appreciated.

DryLondoner

[tealeaf]

Hi Dry Londoner,
Your TBUT is good As for shirmer test, I understand that an average person with no dry eyes is 10mm. Maybe having a plug in your right eye will improve your overall eyes comfort.

What eye drops are you using?

I read from this forum that Dr Latkany mentioned eye plugs are underutilised, seems like he does favour eye plugs (those permanent plug with caps). On my next appointment, am going to ask my Opth. on that since my current temporary plugs seem to be working.

Hope they will be people to answer your questions.

[peter56]

Hi DryLondoner,
congratulation!
Your doc measured a BUT of 12 secs.
He measured a non existing lipid layer on an almost non existing tear film of 2mm in the right eye,
that is really great.
Did you apply eye drops right before the measurements took place?
The Lipid layer in healthy eyes is about 100-120nm - 1/10000mm.
Not to mention your mucin-lubricin - gel tear film layer.
The schirmer is always not very reliable. but the measurement of the BUT should be more simple.

So how you can have a good working stable tear film in your right eye at all?

All the signs you are describing, are indications that you are suffering severe dry eyes and severe
MGD! But considering your low schirmer also in your left eye, the MGD doesn't matter much at all.

Did your doc make the BUT at the slitlamp or with a NIBUT device?

If they do use a NIBUT they do get frequently very strange results. So that people with bone dry eyes do have
a BUT of >7 secs. Sometimes even >10 secs.

[DryLondoner]

Hi Peter,

Thanks for you reply!

He used eyes drops mixed with dye, I then blinked a couple of times and he looked through a slit lamp. I made sure I didn't put any drops in a couple of hours before the appointment because I read somewhere on here this can affect your tests. It was very hard to keep my eyes open for this long but he pushed me to do so...

My last three schirmers have been pretty consistently the numbers above, however he refuses to do them anymore as he says they are unreliable. I asked about how they can be unreliable when they are always so consistent, but he didn't want to discuss that.

Is it possible to have dry eyes and not have any staining? He has shown me the photos, and they look pretty healthy (no dark marks) however these were not taken before the TBUT test. He says the drops wouldn't cover up the staining, as this is not how it works. I want to believe him, but it's hard when it's the man who I feel ruined my eyes...

I can see a few bumps on the my eyelids which have appeared in the last day or so, but I am too scared to do hot compresses as they seem to irritate my eyes even more! Of course I might have interior MGD...

[DryLondoner]

All of this started after I took a short flight (4 hours).

I am wondering if there is another medical reason behind what is happening (and hoping it is one that a magic pill can solve, yeah right?!). I do find when I concentrate on breathing my eyes feel better and are less red.

To make things even more confusing, when I drink water, walk down a busy street, do anything were my breathing might be a bit heavier they get redder almost instantly....I only noticed this as I was drinking water in front a mirror, and they went from normal to red in 20 seconds...strange right?!

[DryLondoner]

Hi TeaLeaf,

How are you doing?

I asked for plugs, but they (I see a surgeon and opth.) say my eyes aren't bad enough because of my amazing TBUT. Also, I have dust allergies, so I don't want to trap allergens in my eyes...

At the moment I am using Systane Ultra, minimally as it does cause grittiness. I have also been given some refresh contacts to try.

[peter56]

Hello Dryl.
according to your BUT results, you do have healthy eyes with a good and stable tear film.
Many people with healthy eyes that have to work at a computer screen do have much lower BUTs.
The BUT does represent the quality of the tear film and is the most important diagnostic indicator!
According to the schrimer results, you do have mild dryness in the left eye and severe dry eye in the right one.

The symptoms your are describing are clearly indications for a moderate to severe MGD!

Yes, there are people that do have normal BUT and schirmer, but do still have most severe ocular - tear film related
problems. In these cases even the most experienced dry eye experts do give up.
For these patients only soft CL-sclerals and Special lipid-eye drops and ointments will work and ease the
problems.

You may test the corneal sensivity and neuronal tears reflex arc in your eyes by trying some stimulations.

1. Are there comming tears while you are yawning?
2. Buy a very sour chewing gum or acid drop. Like the Hammerhead gum for example.
3. What happens if you are Peeling and cutting onions. Are comming tears or do the eyes only burn and
getting red.
4. Try the nasal stimulation. Placing a cue tip in both nostrils, press the cue tips at the mucous membranes in the nose and move the cue tips up and down, thereby rubbing-irritating the mucous membranes. This test may be somewhat painful, but is the most intensive stimulation, beside intensive crying.

Please apply artif tears or better a gel every one hour!
Your right eye is so dry, that one time a day is nothing.

[DryLondoner]

Thanks, Peter!

You sound very knowledgeable about this stuff!

One question - if I have a good TBUT doesn't that mean my oil producing glands are doing a good job? The hot compress/expression seems to irratate my eyes so much I've stopped it. I do however take Omega 3 and sea Buckthorne oil daily.

I suppose this alone is not enough?

The problem with artificial tears, is that they make eyes grittier after a minute or two. I haven't left my house for the last two days, and they've felt much better! I've only had to use the drops twice.

I am trying to find studies/evidence which shows a correlation between dry eyes and poor circulation. I've very bad circulation, always have cold toes and fingers etc. I also think I might have low oxygen levels - although this is just a theory...I find when I exercise indoors I feel a little better and they look better! I know my breathing at night is very poor, as I always have a congested nose due to allergies.

Thanks for all your help, it's been really useful - I will try some of the tests out - does it have be a real yawn?? There are no tears when I fake yawn - at least none that I feel!

The surgeon did a test where he poked my eye with a fibre of some sort, apparently I have decreased sensitivity in one eye - the one which is a drier!

[LaDiva]

Hi DryL,
Have you been checked for ocular rosacea?

[DryLondoner]

Hi LaDiva,

No-one has mentioned this, I've look at the causes/symptoms and they don't ring any bells.

I'm on holiday at the moment, and have managed to do lots of things around the house without them getting uncomfortable or tired until around 5 in the evening...which makes me feel like me might just be dry eye rather than another factor.

[DryLondoner]

Peter - I have tears in both eyes when I yawn!

This is a good thing, right?

[tealeaf]

DryLondoner,

My eyes are not doing very good recently, guess the temporary eye plugs have dissolved. Supposed to last 2 to 6 months but they are gone within 3 weeks! (When I put in eye drops, I can feel the drops flow straight to my throat!). Seem like the tear ducts are wider now after placing the plugs, wonder will they ever shrink back in size should no plugs are inserted.

Oh, I have tears in my eyes too when yawn! So, I suppose our corneal sensivity and neuronal tears reflex arc are working.

My eyes feel drier or stickier with warm compress (not sure why). Have reduced to once a day instead of twice to see if that help.

[DryLondoner]

I'm so sorry to hear that tealeaf - have you made an appointment with the person treating you?

Have they suggested anything else apart from plugs and drops?

They might stickier if you AD and you are releasing more oils - which you might already have enough off (although AD can cause your m. glands to stop working so prob. best to carry on anyway). I found that dipping a cottonbud into boiled (slightly cooled) water and then using this on my eyelids margins was a bit better...

Are you keeping a food diary? It might be worth doing to see if there anything triggering your symptoms.

[peter56]

Hello Dryl.,
in healthy eyes there is tearing, if the corneas are being touched by a fibre-hank of wool.
That is the lowest level of stimulation.
Tearing while yawning is also a good sign.
Please try also the onions Peeling!

There are eyes that are only tearing after stimulations.
But what we all do need is a permanent Schirmer >7-8mm during day time.

Your schirmer and the BUTs results are absolutely conflicting!

One schirmer or BUT does say almost nothing.
Frequently People do have a BUT of >8 secs and a month later desert in the eyes and one week later some secs again and son on.
Also the schirmer I and II are not very reliable and many patients don't like them at all.

What you now do need are 4-5 BUT test sessions.
Taking two BUT measurement in one session and that 4-5 times within 6-8 weeks.

Carefully meassured BUTs at the slit lamp are the best diagnostic tools available currently.
Every new dry eye patient should get These 4-5 BUTs!!!
Since the majority of ophthalm can't perform these BUTs in their practice one time a week and that 5 times,
patients may look for a good optometrist to perferm the BUTs.

Lipiview is also a good diagnostic tool, but a very expensive one.
Here in western europe almost all ophthalm do only apply Lipiview, if the patients then pay for a Lipiflow Treatment
too. That means always paying 1100 euro-1000-GBP to get a LIpiview examination.
I don't know how the ophthalm do handle that in the USA. We have also to notice, that one Lipiview test does
only show the tear film at that moment!

MGD is chronic and progressive!
So starting the best possible Treatments as early as possible is most important to prevent getting into a chronic and
irreversible situation.

[tealeaf]

Hi DryLondoner,

What the opth. suggested were warm compress, plugs and theratears capsules. He asked me to try Retain MGD tear drops, as expected, my eyes felt so uncomfortable after using it. He said the next round, to try a spray that is supposed to increase tears production.

What is AD?

I do not have allergies prior to lasik, in that case, will a food diary help?