Big issue; please help -- dry eye, infection or? Nothing seems to be working

[chella21279]

So 3 weeks ago i went to a massage parlor and had my eyes pressed against a cotton cloth for about 30 minutes while i was getting a massage (massage only, no facial etc). When i got up both of my eyes were extremely blurry. I couldn't even see my phone or drive home. I waited about 10-15 minutes and it had gotten a tiny better so i decided to drive home. Long story short...it took about 3 hours for the blurriness to go away. And that's when the irritation started.

When the irritation began that night, I noticed i started to constantly blink. The bottom of my inner eyelids felt bothersome. No pain though just very irritated and i guess dry. Next morning I went to see an optometrist. Cornea and visiion were all normal. She diagnosed me with dry eye and prescribed Systane Ultra and do warm compressed twice a day. However, needless to say, the next day symptoms had gotten worse

A few days later, i decided to go see another optometrist (who seemed to have helped my issue I had a few years back - he really he knew what he was talking about at the time). So that day he ran some testing and one test showed I had inflammation (not an infection). Another test he ran, showed I had insufficient quality of tears (not quantity). He then diagnosed me with inflammation in my bottom inner eyelids which is caused by dry eye disease. He then put me on azasite (2x's a day for first 2 days and once a week for 1 week) and Fresh Kote and told me it should get better within 2-3 days.

Four days later I am still suffering So I decided to go see a corneal specialist (specializing in dry eye). He looks at my eyes and stated I have inflammation and also thinks I have dry eye disease. He told me to continue the azasite. But also added Lotemax (3 times daily for two weeks) to my daily regimen. He said if it doesn't clear up within two weeks, he was going to put me on restasis.

5 days later I am still feeling crappy. Eyes are still really red upon waking up. At different times of the day I would get ichiness, feeling foreign sensations and stinging. However, the azasite did make it feel a bit better (after 4-5 hours upon usage only)..then I would need to use an artificial tear again. The lotemax didn't feel like it did much though. I do feel that I am not blinking as much anymore though but still not great.

So I decided to see another ophthalmologist, which was just past wednesday (good friend referral, also the last doctor I've seen). He did a Schimers test and it came out normal. And looked at my eyes and saw inflammation/infection and therefore stated I definitely DO NOT have dry eye. He said its an infection, in turn making me feel like I have dry eye. He stated the dry eye feeling is a reaction to the infection/inflammation. Thus, he suggested to stop all the medications and prescribed me with Tobradex ST (4 times a day for 1 week).

Today is Sunday, I woke up and my inner corners of my eyes are now even more red and swollen. They sometimes hurt as well. I called the same doctor and he told me to stop the Tobradex ST and just use artificial tears and warm compresses until I see him on Wednesday. I do notice I am not using the artificial tears as often and the bottom of my eyelids don't feel as irritated as they did. So in some ways, it IS getting better.

I know I shouldn't have seen so many doctors but I am scared out of my mind. The thing that bothers me most is not being able to sleep more than 5 hours a night. Every morning I wake up with my eyes feeling very dry, red and irritated eyes (usually goes away within an hour or two after I insert artificial tears).

What really baffles me is how all this started. How can I get off a massage bed, after having applied pressure for only 30 minutes and caught dry eye disease? Ive never had dry eye or any issues with my eye in the past. I dont wear any contacts and rarely wear any make up. I just know I have really sensitive eyes.

At this point, I am not sure what to do or think. I am just praying for the best. Luckily all the doctors I've seen, said my cornea has not been effected. FYI, I am female, 35 years old.

Any advice? Suggestions? I need help. (btw, I will not be seeing anymore doctors - I plan on sticking with this doctor).

Thanks in advance.

[chella21279]

BUMP! Anybody?

[Rebecca Petris]

Yikes!

Two optometrist and two ophthalmologists in less than 3 weeks. Ouch. That is a recipe for confusion, for sure. I am going to go out on a limb and say that you should consider not returning to ophthalmologist #2. Three doctors who sound pretty reasonably intelligent have agreed you have dry eye (it is absolutely normal and natural that they would not be identical in their treatment plan) - and the fourth says no? Re: that MD #2, do you remember, when he did the schirmer test, did he put any anaesthetic drops in your eye first? If not, that would explain the 'normal' result. It might be that you have 'normal' reflex tearing but poor basal tears.

Did any of these doctors talk to you about your meibomian glands? (That's the oil glands in the eyelids, with tiny openings at the base of your eyelashes, that secrete oil which floats on your tears and prevents them from evaporating too quickly.) Clearly they are pretty much all seeing something wrong with those glands hence the Azasite, warm compresses, etc as those are common treatments for meibomian gland dysfunction. MGD, by the way, is the most common form of dry eye.

NOW, how does all this relate to the day you got a massage? It's probably time to let go of the connection. MGD doesn't start up overnight BUT it's not uncommon for the symptoms to start up very suddenly after a particular trigger. I'm assuming the blurry vision was all about the pressure on the eyes (that's normal) but also perhaps it's possible you got some very-very slight abrasions somewhere during that process? Slight enough not to be evident on examination the next day (again normal - corneal epithelium repairs itself very quickly) but maybe enough to be your personal trigger for a real true dry eye 'episode'. Think of it as something that's been brewing for quite awhile, then something tipped it over the edge into full-blown mini-crisis. That is a pretty common pattern amongst DEZ folks and it will take time and patience and persistence to deal with.

It sounds like you were actually starting to improve until switching to the Tobradex, and now that you're back off that it's again starting to mend? Sounds like you're going in the right direction. Remember to expect things to mend slowly BUT any sign that something is making you worse (increased redness or inflammation) should be a trigger to get off it asap, whether it's an over the counter drop or Rx unless the doctor has a darned good explanation for why you should stay on it.

Meantime - nights. There's lots of things to help you through the night in addition to artificial tears. It can be as simple as plastic wrap (cut a couple of squares, maybe 3x3 inches at the most, and pat them down over the eyes). or a sleep mask. Or taping the lids down if it won't bother you too much... best way to guarantee a night's sleep despite dry eyes that I know There's lots of gear you can get, like Tranquileyes goggles and such, but you might not want/need to invest in that till you know where this is going.

What issue did you have with your eyes a few years back that the first optometrist helped you with?