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

[tealeaf]

Hi Peter56,

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!

May I know what's the difference between stimulation of yawning and 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.

How to maintain a permanent Schirmer >7-8mm? Will plugs help?

Your schirmer and the BUTs results are absolutely conflicting!

Do results of low schirmer and good TBUT mean there is only issue with aqeous deficiency and not lipid layer?

[DryLondoner]

TeaLeaf: AD = Aqueous deficient. My eyes were not allergic before lasik, but from reasing on here and online I do believe our eyes become more sensitive after the procedure. It might be worth considering....

Thanks for the info Peter - I'll look into having regular TBUTs - I have to say, it's very warm in London, and I've been staying indoors, and this is the best they've felt in some time!

Now if I could just find a way to live and earn money without having to leave my house....

[tealeaf]

Hi DryLondoner,
I am definitely AD given that I have consistent shirmer results of 0mm (R) and 2mm (L).

Yesterday I tried onion peeling, the eyes burnt and teared. So, I guess that's a good sign with regard to cornea sensitivity.

It's not easy to find a good optometrist to do regular TBUTs.

[peter56]

Hi Tealeaf,
there are different levels of stimulation levels.
If eyes to react to low level stimulations, like yawning, zigarette smoke, wind etc, it is very likely that the
schirmer is not so low and more permanent.
So the neuronal tears reflex arc is still working more or less well.

If it takes intensive Stimulation, like crying, nasal rubbing, or even Pilocarpine-Evoxac, then the probability
restoring a good TF may be not so high.

If the aqeous-mucin-lubricin - GEL TF is too thin, even the best meibum is useless.
The meibum-lipid layer of 100-120nm in healthy eyes, has to spread over the TF preventing the rapid Evaporation.
If there is no Minimum TF gel layer, nothing can spread and thus no stable TF build-up.
Without a stable lipid layer, the thin TF will evaporate even more rapidly.

Plugs will increase the aqeous tears quantity. But it takes also mucins etc. to have a good gel layer.
Without a minimum level 3, respec. 6 layered TF, a stable TF will not build-up on the corneas.

Even with a permanent schirmer of >30mm, without the other components, the tears will simple
run down to the lower lid sack.
If your schirmers are really so low, you do suffer most severe dry eyes.
In that Situation, the MGs-meibum is no issue and doesn't matter.

So you may try increasing the watery tears, treating the iflammation in order to get more mucin producing
goblet cells.

Do you suffer post LASIK dry eyes or what are the causes.

[tealeaf]

Hi Peter56,

Thank you for your reply.

I suffer from post Lasik dry eyes.

My latest TBUTs are 7-8 sec for L eye and 12 sec for R eye. Whenever I do warm compress, my eyes feel sticky after that. I asked my opth. if my eyelids are producing oil, he said ok though I have mild Blepharities.

Currently, doctor puts in temporary eye plugs in my lower tear ducts. They really help as I feel much more comfortable and not so afraid of wind and aircon blowing.

Do goblet cells regenerate for post lasik patients?

[peter56]

Hi Tealeaf,
did you see an ophthalm of the team of prof Donald Tan at SNEC?

I can't imaging that an eye that does have schirmer 0mm-like desert should have a BUT of 12 secs.
Bone dry eyes with a BUT like in healthy eyes, how that can be? Why you do have most severe ocular problems with such formidable BUTs??

Why even experienced ophthalm don't recognize the total contradictional schirmer and BUT results???

I do have a permanent schirmer of 10-12mm. But since I have almost no more working MGs, my BUTs is a few secs only.

A break-down of the aqeous tears production after LASIK is typical for this disorder.
So I think your schirmer tests are realistic.

According to your schirmer you do have most severe dry eyes!
No more TF and not to mention the lipid layers.


The latest recommandations for the treatment of post LASIK dry eyes are:

1. Punctal plugs or permanent cauterization,
2. Rebamipide 2% eye drops Suspension, to suppress the inflammation in the cornea-conjunctiva,
thereby increasing the - MUC1, MUC4 and MUC16 Membrane mucins and the MUC5AC goblet cells mucins
and the aqueous tears.
Steroid ointment and Naltrexone drops do also improve the functioning of the corneal nerves.
3. Diquafosol - DQS 3% eye drops, also to improve the mucins and overall conditions.
4. Taclolimus anti-inflammatory eye drops 0.1%
5. Applying sufficient artif tears - gels, if there are severe mechanical irritations of the cornea-OS,
Bandage CL for a few weeks up to a few months.
6. Trying to stimulate the tears production, like onions peeling etc.
Later on if it seems that the tears reflex arc does work better, a pulse therapy with Pilocarpine-Evoxac.
7. Right after a permanent watery "tear film" of schirmer >6-8 has been restored,
starting the meibomian gland dysfunction Treatment!

I don't know, if Rebamipide and Diquafosol drops are available in Singapore.
Most People that do have so dry eyes like your ones, are being forced to wear sclerals.

The treatments are a long way to go for you and nobody can really say, how much damage the LASIK has caused in the nerves of your corneas!

So it is a very difficult decision, trying all these therapies or being forced to wear sclerals for the rest of
a very long life???

[Rebecca Petris]

The latest recommandations for the treatment of post LASIK dry eyes are:

Peter,

Who came up with this list of recommended treatments for post LASIK dry eyes? You make it sound like something official so please clarify the source.

[kylix]

Peter,
can I please ask about preservatives in Diquas, what do you think of them? Is effect of Diquafosol so good that people don't have to worry with that? Is the damage done by them 'reversed' by active ingredients in them and even improved further? According to the recent studies on them, doctors don't seem to be worry. Only praising their healing potential.

[Gerri55455]

[/QUOTE=DryLondoner;91890]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.[/QUOTE]

DryLondoner, your story is my story--with one exception: I never had Lasik surgery.

Granted, I got 'addicted' to using the computer for long hours without blinking. And as I hit my mid-40s, that just wasn't sustainable. So I developed dry eyes six and a half years ago. But after the first two rocky years, I really thought I'd learned how to cope with my dry eyes.

Then in 2013, I used FML and discontinued therapy after seven days. Those who have responded to my posts tell me that the problem was that I did not 'taper off' this drug. But if using a drug 2X/day for four days then 1X/day for three days is not 'tapering off', then I just don't know what 'tapering off' means.

In my six and half years of dealing with dry eyes, I've NOT used steroids for more than six months (total). I'd used FML twice before, but finished the course of treatment each time (4 weeks). I did not experience any problem then. I'd also LOTEMAX before and discontinued therapy cold turkey: after seven days at 4X/day. I did not experience any problem then.

I am persuaded that FML begins by making one's eyes feel worse, then curing them over the course of 4 weeks. If that process is interrupted, it makes the initial condition worse than it was before.

My doctor is tired of hearing me ask why my eyelids burn, itch and feel gritty. Why does blinking feel like scraping and so terribly uncomfortable if my schirmers are relatively good, my cornea looks good and my TBUT is good. I did warm (even hot) compresses for 5 years. Since last year, I have stopped. They inflame my eyes way too much. I'd also used Restasis for two years. Since last year, that irritates my eyes too.

I have changed nothing in my life. My office remains the same, my house remains the same. But since discontinuing FML before the end of the 4-week treatment last year, my life has been turned upside down.

I am still using autologous serum. I'm hoping to go see a different doctor in Chicago next month. I hope that I can find something that really takes me back to where I was in May 2013. I still had dry eyes, but my eyes weren't as bad as they are. I'd taken 10+ hour flights and read all the way through. Now, I can't even read in my house.

If I find something, I'll post it here. If you do, please share.

Good luck!

~Gerri

[Gerri55455]

The problem with artificial tears, is that they make eyes grittier after a minute or two.

This is my story too. BUT..., this feeling of grittiness after using artificial tears only began after my FML disaster.

Sorry to sound like a broken record on this issue. However, I've dealt with dry eyes for six and half years and while the dryness was getting worse with time and especially during the winter (I live in Minnesota), only since last year have I felt "unable to live a normal life."

In a post entitled "Bacterial MGD" on this site, Angela writes: "I do believe that I had a bad reaction to FML ointment despite what everyone keeps telling me about it being near impossible to be allergic to FML. Either way, it certainly didn't make matters better and I've tried it twice, each time for 10 days."

I've tried to write her (and other folks who believe they had a bad reaction to FML) to no avail.

Following the FML disaster, 2 months of Prednisolone made my eyes even worse.

Now here is the thing: before FML last year, I could fly from the US to the Caribbean, to Europe, to Africa ... and read throughout the flight. Only the computer dried my eyes! Now, I have to wear moisture chambers every moment of my life (day and night).

So yes: sensitivity to a certain product installed in the eye can make matters very bad. The issue for me is to know how to reverse the probelm. My success with serum has been minimal but appreciated nontheless.

~Gerri

~Gerri

[Gerri55455]

Steroid ointment and Naltrexone drops do also improve the functioning of the corneal nerves. So it is a very difficult decision, trying all these therapies or being forced to wear sclerals for the rest of a very long life???

I wrote Dr. Perry Rosenthal an email about Naltrexone. He asked me to discuss this with my doctor. I will do so. However, I do not want to touch a steroid. Is Naltrexone a steroid-like product?

My doctor also recommended sclerals ... he says my eyes are not dry but he's tried everything! But I believe that I need to heal my eyelids -- they are the ones that are irritated and not the cornea!

[buntbean]

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.

I'm interested in hearing more about this Peter. I've been suffering for 9+ years with MGD/ocular rosacea/corneal neuralgia. My corneal specialist never does anything concerning my glands. Just tells me to do compresses and take flaxseed. My glands are always clogged sometimes so bad nothing comes out. In desperation I actually put gloves on and put one finger on one side of my lid margin and one on the other and squeeze. I know I need to look for someone else who will better explain the MGD. I live 2 hours away from Boston.

[DryLondoner]

I wrote Dr. Perry Rosenthal an email about Naltrexone. He asked me to discuss this with my doctor. I will do so. However, I do not want to touch a steroid. Is Naltrexone a steroid-like product?

My doctor also recommended sclerals ... he says my eyes are not dry but he's tried everything! But I believe that I need to heal my eyelids -- they are the ones that are irritated and not the cornea!

Hi Gerri,

Hope you are ok.

So three months after taking steroid drops which sent my eyes into a downward spiral it seems they are calming down a little bit.

The stinging and burning has been gone for at least a week. They feel moister than 3 months ago. They still itch, but this is occasional and the grittiness seems to have gone too!!

I'm crossing everything as I write this. I had plugs put in as they still aren't normal.

Things I've done in the last month:

-moved to a humid country
-stopped all supplements
- started exercising regularly
- eating more (more veg, good fats, lots of protein)
- reduced stress
- reduced computer time
- reduced eye drops (to about once a week)
- blinking excersises (gentle full blinks as if I'm falling asleep as often as I remember)

I'm still trying to get serum, my eyes still feel uncomfortable around moving air, I'm hoping serum will allow them to heal fully. My plugs are painful, they feel like they are scratching me eyes when I make sudden eye moved movements. But after two days I can tell me eyes are wetter and less red so will give them another couple of days to "settle".

Hope you are making progress too!

[DryLondoner]

Two things which I missed off...

A) I clean my eyes very very carefully every evening. I use a gentle makeup remover, and then use cotton buds soaked in olive oil. I did this pre-LASIK, I found the olive oil really helped remove all the makeup. I stopped post LASIK as i didn't want to irratate my eyes. But I find it helps, they are thoroughly clean after the oil. I think take a warm muslin washcloth and gently clean around the eyes.

B) I've noticed in the past two weeks that when I wake up I have mucus is the corner on my left eye (my better eye) I Shays had this pre-Lasik, but haven't for the past year.
I don't know what this means, but take it as a good sign. My left eye is now less red when I wake up too.

I'm hoping that with time my right eye will catch up.

I also have less mucus during the day now. I use to have to clean the corners every couple of hours, it's down to once a day, and I try to ignore it, I don't want to touch me eyes or need with them in case I make things worse.

Regarding the supplements, I stopped the omega oils as I read somewhere they can make you anxious. On this firm somewhere actually. I was very anxious, I would cry all the time. At least once a day, if not more. I have stopped them for 3 weeks and feel so much better!! Of course this coincides with my symptoms getting better, so could just be a coincidence.

[Gerri55455]

my eyes still feel uncomfortable around moving air, I'm hoping serum will allow them to heal fully.

Hi DL,

Nice to hear from you. I'm often looking out for your posts as I feel persuaded that we are experiencing very similar symptoms.

I'm so glad that you are feeling better. I wonder why your eye doctor used plugs that you feel when you blink! I wish I could tell you what the brand of plugs my doctor used is. Unfortunately, I'd have to ask this at my next appointment.

I was quadra-plugged in June. The area around my tear ducts itched a lot after the plugs were inserted. But to be honest, I do not suffer from aqueous deficiency. It's my corneal epithelium and ocular surface that are irritated. In the end, I teared way too much and decided to remove the upper plugs.

Anyway, two months ago, I purchased an omega masticating juicer and I've been juicing a lot. I also eat a lot of leafy greens (collards, spinach ... especially) and have included more fruit in my diet than ever before.

I still take a teaspoon of Nordic Naturals fish oil with my breakfast; a tablespoon of Flax seed oil with lunch; and a tablespoon of hemp seed oil with dinner. I mainly take these oils because I don't eat fried food, don't eat dairy... and hence no butter, and these are the only oils that help with the absorption of my nutrients (my collards would be too harsh on the stomach without the oil).

There are days when I feel better than others. Serum has certainly helped with corneal neuralgia but progress is slow.

Currently, I am thinking of trying 100mg of Doxycycline for a couple of weeks, or perhaps a month. Before the steroid disaster, Doxy had helped tremendously but caused gastric distress. So I'm a little afraid of going back to Doxy. But I've lately found a good probiotic (Bio-K Plus-Soy) which I've been taking and hope to take 3-4 hours before each 100mg of Doxy to ease the stress on my stomach.

I have also reduced my computer time considerably.

But I must say that I agree with you about moving air! I was away from an office setting between early April and late August this year. Coming back to air-conditioned offices has been a real affliction! Oh, what a torment sitting through meetings has been this month!

Recently, I have located an optic store in downtown Minneapolis willing to install moisture chambers on a pair of prescription glasses (to avoid my having to wear Wiley's or 7 Eye to the office). So this Friday my plan is to scour optic stores for an appropriate frame. I believe blocking out all moving air from my eyes will help me be functional even as I continue to seek solutions that carry fewer side effects, and more positive results than oral and topical medications.

I hope you continue to feel better ....

Thanks again for sharing!

All the best,

~Gerri