Side effects of long term use of genteal gel...

[Hokucat]

Milo007 , no I did not have meibography when my symptoms first started since that was back in 2007 before it was available. However when I had my first probing, the doctor said I only had a few glands that expressed any oil when he pressed on them during my probe consult, and the oil was very little and very thick like Crisco oil. When he did the probing, that is when he told me I had scar tissue in several glands.

I had both severe aqueous deficiency (zero Schirmers) and severe MGD. The doctors suspect autoimmune disease, but likely it was complicated by years of using my eyes excessively on the computer and my three hour daily round trip commute to work...both which are known to reduce blinking or cause incomplete blinking. In fact even though I can better manage my condition now, I notice if I use the computer too much my eyes start to feel dry again.

So I think unfortunately studying and using the computer could have caused, and could continue to worsen your situation. You probably don’t want to take a break from school, but make sure to take regular breaks to rest your eyes, and do regular blinking exercises. Also treatments like LipiFlow like you’ve asked about in another post may be helpful to get your oils flowing. I also found finding the right diet changes were key for me to help my glands function better, both lacrimal and meibomian, after probing unblocked my glands. So it’s important to address the underlying condition, otherwise you could continue to get worse.

Like diydry, sclerals especially help with reading and the computer, and for me with overall daily functioning and comfort. So you might look into going for a consult to see if you are able to wear the lenses and if they help your eyes feel better. Not everyone can tolerate them. There are some PROSE scleral clinics in India, and I have been very happy with my PROSE sclerals and doctor.

[Milo007]

Milo007 , no I did not have meibography when my symptoms first started since that was back in 2007 before it was available. However when I had my first probing, the doctor said I only had a few glands that expressed any oil when he pressed on them during my probe consult, and the oil was very little and very thick like Crisco oil. When he did the probing, that is when he told me I had scar tissue in several glands.

I had both severe aqueous deficiency (zero Schirmers) and severe MGD. The doctors suspect autoimmune disease, but likely it was complicated by years of using my eyes excessively on the computer and my three hour daily round trip commute to work...both which are known to reduce blinking or cause incomplete blinking. In fact even though I can better manage my condition now, I notice if I use the computer too much my eyes start to feel dry again.

So I think unfortunately studying and using the computer could have caused, and could continue to worsen your situation. You probably don’t want to take a break from school, but make sure to take regular breaks to rest your eyes, and do regular blinking exercises. Also treatments like LipiFlow like you’ve asked about in another post may be helpful to get your oils flowing. I also found finding the right diet changes were key for me to help my glands function better, both lacrimal and meibomian, after probing unblocked my glands. So it’s important to address the underlying condition, otherwise you could continue to get worse.

Like diydry, sclerals especially help with reading and the computer, and for me with overall daily functioning and comfort. So you might look into going for a consult to see if you are able to wear the lenses and if they help your eyes feel better. Not everyone can tolerate them. There are some PROSE scleral clinics in India, and I have been very happy with my PROSE sclerals and doctor.

Thanks for the cordial response hokucat.

Honestly I have been so depressed over the last few days realizing now that my career and ambitions are at stake. It's like the whole world has suddenly turned different in two days. I am very low in confidence and nervous as well with episodes of psychological depression. It's all affecting my life not for the good.

I agree 100% with you on the fact that my condition was caused by excessive use of computers and smartphones too for the past 9 years. I used to spend 8-12 hours on the PC for the first 5 years and then maybe 4-5 hours for the next 4 years until my eyes finally started letting me know about the damage. Even though my meibography shows moderate gland loss I have very little oil secretions I guess. Maybe some of my glands are scarred too. I don't know whether they do a probing in the eye hospital I am referring to or in any other place in India.I desperately need a doctor who can probe my glands.

I am yet to undergo lipiflow. But it might work for me. Honestly, I am not thrilled about it after reading mixed responses of various patients. Since you are a kind hearted lady I guess you can understand the agony and pain I am through at this moment. I have surrendered everything to God to be honest. I believe in miracles but I also believe in the cosmic will. I can only pray to get my condition improved.

I met another patient from India in this forum itself who's also a MGD sufferer and have visited the same eye hospital as I did. He did a lipiflow not to any significant benefit. But his doctor (who's the departmental head for Dry eye) said the next option would be scleral lenses. He probably doesn't perform a probing.

I would like to ask if sceral lenses come with potential side effects. I have read that contact lenses are one of the causes for dry eye development. Are sceral lenses expected to aggravate meibomian gland drop out or lacrimal gland dysfunction?

Also, you wrote sceral lenses are not tolerant to everyone. Is it due to discomfort or an allergic response to them? How effectively are you able to perform focusing activities like reading with the sclerals on and for how long?

I am really looking forward to evaluating all options to save my career. Thanks for the support again.

God bless you

[diydry]

Oh no I agree MGD is the main culprit for me. All the doctors say as much and I have many blocked glands and ocular rosacea. I'm guessing some aqueous deficiency still plays a role because my schirmer tests show sub-optimal tear production, my eyes get dryer as the day goes on, and I had corneal staining in both eyes for several months after my procedure.

As for sclerals, milo007, you are right to be skeptical of expensive treatments and raise good questions about the side effects. The good news is that with both Lipiflow and scleral lenses, reports of side effects seem pretty small. (The bad news is they can be expensive). Sometimes with sclerals people complain of discomfort and redness after wearing for several hours, this happens to me for example. Others can't tolerate them at all. I think the reason people experience discomfort is because there's a giant plastic lens in your eye! Although it can also be due to needing a better fit, or a bigger/smaller lens, and lots of other things.

I haven't seen any evidence anecdotally or scientific that scleral lenses aggravate meibomian gland drop out or lacrimal gland dysfunction. If anything, I think there is hope that they may have therapeutic benefits.

[Hokucat]

You still have the majority of your glands and have not tried any of the next level treatments yet, so there’s still a lot of hope. I struggled with severe dry eyes for 8+ years, and I am able to manage my condition despite several of my glands atrophying over those years while trying to find resolution. There’s so much more even in the last five years in terms of diagnostic tools, treatments, and information that there’s a very likely chance of getting better much sooner, so hang in there.

I would recommend trying less invasive treatments like LipiFlow, gland expression, and IPL before probing. If those treatments help your oils flow, even for a short time, then you probably don’t have scar tissue like I did, and probing is not necessary.

There can be different reasons people cannot tolerate sclerals. As diydry mentioned, having a large rigid gas permeable lens in your eyes can be uncomfortable to some (it’s ~size of a nickel), and the fit of the lens needs to be right for your eye. But know that the lenses do not lay on the cornea...only the edges lay on the white/scleral part of the eye which is less sensitive. Also, the expertise of the scleral fitter can make a huge difference in your success being able to tolerate the lenses. Another reason people cannot tolerate sclerals may be their tear film. This happened to me the first time I wore sclerals when my dryness was not at its worst. The first half year it helped me use the computer, read, drive, walk outside, etc. Then as my condition worsened to zero tear film, I could no longer tolerate my sclerals. It was not until after probing+diet changes that I got a thin tear film back, and I was able to tolerate my sclerals again. But I’ve also heard of people with little or no tear film who are able to wear sclerals.

I have not heard of any long term side effects from sclerals, nor have I experienced any. Yes sclerals do help me with focusing and reading longer than without them, but the degree to which they help will differ with each person. Best to go for a scleral consult where they have you try on a trial pair for an hour or so (at least PROSE does this) to see if you can wear them, and if it helps you function more comfortably with those things like looking at your phone, reading, going outside, etc.

[Milo007]

You still have the majority of your glands and have not tried any of the next level treatments yet, so there’s still a lot of hope. I struggled with severe dry eyes for 8+ years, and I am able to manage my condition despite several of my glands atrophying over those years while trying to find resolution. There’s so much more even in the last five years in terms of diagnostic tools, treatments, and information that there’s a very likely chance of getting better much sooner, so hang in there.

I would recommend trying less invasive treatments like LipiFlow, gland expression, and IPL before probing. If those treatments help your oils flow, even for a short time, then you probably don’t have scar tissue like I did, and probing is not necessary.

There can be different reasons people cannot tolerate sclerals. As diydry mentioned, having a large rigid gas permeable lens in your eyes can be uncomfortable to some (it’s ~size of a nickel), and the fit of the lens needs to be right for your eye. But know that the lenses do not lay on the cornea...only the edges lay on the white/scleral part of the eye which is less sensitive. Also, the expertise of the scleral fitter can make a huge difference in your success being able to tolerate the lenses. Another reason people cannot tolerate sclerals may be their tear film. This happened to me the first time I wore sclerals when my dryness was not at its worst. The first half year it helped me use the computer, read, drive, walk outside, etc. Then as my condition worsened to zero tear film, I could no longer tolerate my sclerals. It was not until after probing+diet changes that I got a thin tear film back, and I was able to tolerate my sclerals again. But I’ve also heard of people with little or no tear film who are able to wear sclerals.

I have not heard of any long term side effects from sclerals, nor have I experienced any. Yes sclerals do help me with focusing and reading longer than without them, but the degree to which they help will differ with each person. Best to go for a scleral consult where they have you try on a trial pair for an hour or so (at least PROSE does this) to see if you can wear them, and if it helps you function more comfortably with those things like looking at your phone, reading, going outside, etc.

Thanks again hokucat! You are a kind lady.

You said if oils flow from my glands then it's probable that I don't have scar tissue. Well I wipe my lower lid margins on each eye with a q-tip and then press with a nominal force the q-tip at various locations of the outer eyelid surface standing in front of a mirror with a bright light to see if oils flow out. And I can clearly see dots of clear oil flowing out after a few seconds of applying pressure more on my left lower eyelid margin and relatively less on my right lower eyelid margin. Upon blinking once after manually expressing the oils my vision goes blurry more in my left eye and relatively less in my right eye. I could see about 12-15 gland openings secreting oils like this maybe a bit less than in my right eye lower eyelid. I have not been able to express the upper eyelids as pressure applied to them would raise intra ocular pressure and possibly distort the cornea. But I am still not been able to figure out why my TBUT is just 3 seconds.

Does it mean that the oil quantity is too low for natural expression through a blinking process?

Or maybe the oil quality is poor to be able to create a stable tear film?

I am also a partial blinker and I have been constantly trying to consciously perform a complete blink ever since the doctor told me less than two months ago.

Is it too early to expect an improvement in about two months?

I am also not regular with warm compresses as it irritates sometimes creating inflammation.

Another question : How long does a pair of scleral lens last?

[Hokucat]

I’m not a doctor but based on what you write, it does sound like your partial blinking over the years may be the culprit causing your gland loss/atrophy and the other glands producing less oils. It seems you should have seen at least a little improvement from doing the blinking exercises for a couple months now, but it can take time. Make sure you do the exercises every 20 minutes. It’s good news you can see oils when you press and blink, many cannot.

You could also have poor quality oil. I find my eyes always feel better if I eat the diet I found personally works for me: a rainbow of veggies (more greens), berries, salmon, nuts, green tea with lemon juice, etc. and limit dairy, sugars, and gluten, and drink lots of water throughout the day. In general I eat many foods that are anti-inflammatory, antibiotic, and antibacterial. For me what I eat makes a big difference in helping the quality of my oils from the inside out. And oil quality is really important for me, especially since I have limited glands.

I saw in another post when you were on oral antibiotics you felt a little better? Beside meds and diet helping with bacteria, did your doctor suggest you use a lidscrub for bacteria on your lids? Bacteria can also contribute to MGD. I use Ocusoft Lidscrub Plus Foam which addresses bacteria, but there are several different scrubs and different ones work for different people:

https://dryeyeshop.com/collections/l...yelid-cleanser

Scleral lenses can last at least a few years, however if you get it to include vision correction, if your vision changes you’ll need an update sooner. But what is great about sclerals is, if you are able to wear them, it can provide some degree of immediate relief.