Best eye drops/treatment for Evaporative Dry Eye ?

[Alix]

Hi all

I have been suffering from dry bloodshot eyes since last December. Having seen numerous different opthalmologists who have diagnosed me with different types of dry eye/chronic allergy, the main consensus seems to be that I have Evaporative Dry Eye and therefore should increase usage of eye drops to stablilise my lipids.
Unfortunately the more I use the Systane eye drops I have been recommended (the preservative free ones), the drier/redder my eyes are. I tried a liposomal spray for the first time last week and this made no difference, in any case it contains preservatives so I am reluctant to try this again. I have used different preservative free gels/ointments at night and without fail I wake up with bloodshot eyes which feel worse than when I use nothing. I am in despair. My eyes are very sensitive. What are the best eye drops which work for Evaporative Dry Eye?

[deep_dry_eye]

Are you doing anything to treat the fundamental issue behind your dry eyes?

Which country are you in? Seems like the doctors you've been visiting are not dry eye experts, you need to find a good expert to get a good diagnosis. This is perhaps the most critical step towards getting good treatment.

[hannahmaywils]

I live in the UK and the best drop for me has been Hylo-Forte ( the red bottle)

[Alix]

Hi thank you for your replies so far.

I am based in London, UK and have seen 5 different opthalmologists at Moorfields Eye Hospital, which is considered the best eye hospital in the country....One diagnosed me with chronic allergy and gave me FML steroid drops which made my eyes even worse (more bloodshot). Another diagnosed me with MGD and told me to do warm eye compresses which have made no difference. Another told me it was Aqueous Dry Eye and to use Hycosan (red one). The other two diagnosed me with evaporative dry eye. I had punctal plugs put in but had to have them taken out after one month as my eyes became very itchy and even more bloodshot. Now they just burn non stop.

Hycosan (red) which I believe is the same as the red Hylo-Forte one provides only temporary relief (15 mins max). The latest doctor I saw told me these drops would not do anything for me as they are for Aqueous Dry Eye, whereas I have Evaporative Dry Eye therefore Systane is best, except that they make my eyes worse.

All the doctors I have seen so far have recommended I increase my flaxeed/omega 3 intake which I have but I have not seen any improvement so far.

It is so frustrating because I can't find any eye drops which work for me, and it seems the more I use to ease the burning sensation, the worse they look and feel afterwards.

[deep_dry_eye]

Hi thank you for your replies so far.

I am based in London, UK and have seen 5 different opthalmologists at Moorfields Eye Hospital, which is considered the best eye hospital in the country....One diagnosed me with chronic allergy and gave me FML steroid drops which made my eyes even worse (more bloodshot). Another diagnosed me with MGD and told me to do warm eye compresses which have made no difference. Another told me it was Aqueous Dry Eye and to use Hycosan (red one). The other two diagnosed me with evaporative dry eye. I had punctal plugs put in but had to have them taken out after one month as my eyes became very itchy and even more bloodshot. Now they just burn non stop.

Hycosan (red) which I believe is the same as the red Hylo-Forte one provides only temporary relief (15 mins max). The latest doctor I saw told me these drops would not do anything for me as they are for Aqueous Dry Eye, whereas I have Evaporative Dry Eye therefore Systane is best, except that they make my eyes worse.

All the doctors I have seen so far have recommended I increase my flaxeed/omega 3 intake which I have but I have not seen any improvement so far.

It is so frustrating because I can't find any eye drops which work for me, and it seems the more I use to ease the burning sensation, the worse they look and feel afterwards.

Seems like none of these doctors are truely dry eye experts.

Have you had a chance to get a meibography (i.e., LipiView) scan? One of the first step is to get a proper diagnostic. From what it sounds like, you're more likely to have MGD than aqueous dry eye, or you can have a combination of both.

Regardless, both types of dry eyes are theorized to be caused by an autoimmune problem. You should get on Cyclosporin (i.e., Ikervis or Restasis). Ikervis is available in the UK. To treat MGD, you should also go on a trial of Azyter (topical azithromycin) which will help clear and flush your glands. Finally, you should definitely look into IPL and LipiFlow. IPL can further help control and reduce your inflammation , while LipiFlow can help flush out any obstructions inside your glands.

[Alix]

The doctors I have seen so far at Moorfields Eye Hospital may not be dry eye "experts" but it is the best eye hospital in the UK, therefore I am assuming I am seeing the best doctors in the country, which is worrying if all they have to say is use eye drops..... I did ask them if they could give me anything stronger and they said it is for more severe cases where there is corneal damage ?! I could be wrong but I have a feeling that because Ikervis, Azyter etc are very expensive they will only prescribe this if it is absolutely necessary.

There are dry eye clinics where I can pay to see dry eye experts where I imagine I can get a meibography (not had one before) but private consultations are expensive in the UK, so I am trying to find out where would be the best place to go. The Dry Eye Centre in London is only open 2 days a week and reviews are mixed.

My optician mentioned it was worth checking if I have thyroid issues (even though I don't have any symptoms) so I had a blood test done for that last week and am waiting to get back the results.

[Guest]

The doctors I have seen so far at Moorfields Eye Hospital may not be dry eye "experts" but it is the best eye hospital in the UK, therefore I am assuming I am seeing the best doctors in the country, which is worrying if all they have to say is use eye drops..... I did ask them if they could give me anything stronger and they said it is for more severe cases where there is corneal damage ?! I could be wrong but I have a feeling that because Ikervis, Azyter etc are very expensive they will only prescribe this if it is absolutely necessary.

There are dry eye clinics where I can pay to see dry eye experts where I imagine I can get a meibography (not had one before) but private consultations are expensive in the UK, so I am trying to find out where would be the best place to go. The Dry Eye Centre in London is only open 2 days a week and reviews are mixed.

My optician mentioned it was worth checking if I have thyroid issues (even though I don't have any symptoms) so I had a blood test done for that last week and am waiting to get back the results.

Moorfields aren't that great when it comes to dry eye. I have been to various dry eye doctors and found http://dryeyecentre.co.uk/ to be the best. They specialise in dry eye. Most doctors at moorfields don't specialise in dry eye, it's more of a secondary speciality, which means they just trot out the same old NHS lines, eye lid hygiene etc...

Nicola Wood. for example, is an expert on dry eye syndrome. That is pretty much all she deals with, meaning she is way more advanced than your average eye doctor. I have found ophthalmologist's to be lazy when it comes to dry eye.

[deep_dry_eye]

The doctors I have seen so far at Moorfields Eye Hospital may not be dry eye "experts" but it is the best eye hospital in the UK, therefore I am assuming I am seeing the best doctors in the country, which is worrying if all they have to say is use eye drops..... I did ask them if they could give me anything stronger and they said it is for more severe cases where there is corneal damage ?! I could be wrong but I have a feeling that because Ikervis, Azyter etc are very expensive they will only prescribe this if it is absolutely necessary.

There are dry eye clinics where I can pay to see dry eye experts where I imagine I can get a meibography (not had one before) but private consultations are expensive in the UK, so I am trying to find out where would be the best place to go. The Dry Eye Centre in London is only open 2 days a week and reviews are mixed.

My optician mentioned it was worth checking if I have thyroid issues (even though I don't have any symptoms) so I had a blood test done for that last week and am waiting to get back the results.

Drugs should be prescribed as needed by the patient, not due to costs. If we had such a healthcare system, we would end up with a system where the rich can get access to healthcare, while the poor are without. Azyter is actually really cheap. I do not know the price of Ikervis in UK.

You need a meibography to get a good view of your meibomian glands. If you need to go the private route, then I suggest you to go the private route.

[deep_dry_eye]

BTW, a good eye doctor (i.e., ophthalmologist) may have zero knowledge and experience on treating dry eyes. Ophthalmologist education, and experience mostly revolve around surgical (think retinal tears), "dry eyes" usually does not fall into the practice and primary care of ophthalmologists. What I'm trying to say is, you can be a superstar retinal ophthalmologist, but a terrible dry eye consultant. I've seen a lot of very good ophthalmologists, but they misdiagnosed me, or gave me wrong treatment plans for my dry eyes. One (corneal specialist) ophthalmologist even sent me home and told me I just had to live with pain for the rest of my life.

[MGD1701]

Gland image and function are most important. you can have beautiful glands but NO function (= no clear oil seeps when blink/express). Many doctors still do not check/express. Even top expert can NOT see glands atrophy from slit lamp, according to expert Prof Gupta.

Recently visited two doctors who have not even seen gland images. I even had to teach one telling her, what normal glands should look like.

perhaps you could care to read more from my earlier post, if you have missed it
http://forum.dryeyezone.com/forum/ar...a-tea-tree-oil

I could only suggest you educate yourself and find a real expert to stop progression,
best is to get Ikervis, if it is dry eye - bear in mind, if allergy or other causes, Ikervis wont help. Good luck.

[Alix]

When I am in the waiting room at Moorfields before my appointments, I see many people around me who look like they are in much worse situation than I am, so compared to them my complaints must seem so trivial to the doctors, but the non-stop burning sensation is truly debilitating and is affecting every aspect of my life, I can't believe what my life has become..... I agree I need to go down the private route because I am not finding any answers but it is just so expensive, I am already substantial amounts on useless eye drops/gels/ointments/supplements. I have another follow up appointment at Moorfields in 2 weeks time, I will ask the doctor about meibography and Ikervis - if they tell me yet again to just use Systate every hour, I will go and see a dry eye specialist privately whatever the cost, I am reaching the end ...

[MGD1701]

Ikervis helps, drops are not solutions.
you need to do warm compress (not easy to master), lid hygiene and omega 3, GLA.
if blockage, you need to remove sooner by LipiFlow, IPL or try to find a dr who can do manual expression (cheaper and effective too). All costs money/time so it is critical to

Get objective tests/diagnosis done = effective treatment = stop progression

sounds logical/simple but in reality not easy to achieve, at least in my case, although mine is really not that complicated. Only one decent doctor telling me, sorry I can not help you.Too late, many glands are gone, even I have NEVER stopped visiting doctors for some years.

[deep_dry_eye]

When I am in the waiting room at Moorfields before my appointments, I see many people around me who look like they are in much worse situation than I am, so compared to them my complaints must seem so trivial to the doctors, but the non-stop burning sensation is truly debilitating and is affecting every aspect of my life, I can't believe what my life has become..... I agree I need to go down the private route because I am not finding any answers but it is just so expensive, I am already substantial amounts on useless eye drops/gels/ointments/supplements. I have another follow up appointment at Moorfields in 2 weeks time, I will ask the doctor about meibography and Ikervis - if they tell me yet again to just use Systate every hour, I will go and see a dry eye specialist privately whatever the cost, I am reaching the end ...

Artificial tears at best can only mask the symptoms and provide comfort temporary, you need to tackle the fundamental underlying issue causing your dry eyes. No amount of artificial tears can help you tackle the underlying issue.

[Guest]

Alix Moorfields is absolutely rubbish for dry eye in my experience, even worse then my local NHS eye hospital - they gave me Ikervis no problem. Unfortunately if you want to get anywhere with dry eye here in the UK you're going to have to pay for it. I've seen a lot of people so can advise if you have any questions

[MGD1701]

drops for MGD, with lipid
EvoTears (pure oil but very expensive)
Cationorm - PF