Low tear production and/or an allergy causing inflammation

[Matt0029]

I have low tear production and inflammation but since my doc found papillary under my eye lids he thinks there maybe an allergy effecting my eyes too. My tear production is low 4mm in one eye. Any one had a similar problem at identifying what is causing the inflammation?

[Alix]

After consulting over 10 different doctors, and being given various different diagnoses, I have come to the conclusion that at least in my case, eye inflammation is caused not by just one factor but by various different ones, which is why it is so hard to manage. At one point I was on catacrom (for allergy), steroid eye drops (to control inflammation), doxycycline and lubristil all at the same time.
My tear production is ok, my main issue is poor quality lipids but I also have papillary like you. It sounds like your inflammation may also be caused by multiple factors i.e. allergy and aqueous deficiency.

[Matt0029]

Thank you. I am back on steroids and possibly doing a puntual catuery after my next appointment. I have to start tempering off the steroid, softacort after two weeks. I'm frightened the imflammation will come back it did last time after a course of predisnole. It's amazing how good my vision is when the inflammation has cleared. I think my surgeon is abit hesitant about doing an occulsion since finding the papillary as there maybe an allergic component to me ocular problems. The papillary had gone at my last check up I was on opthanol for 2 weeks no change the fml for 2 weeks. I'm now on softacort. Eyes are less imflammed but still sore an dry.

[Alix]

I have been on 2 courses of steroid drops which lasted 6 weeks each, once on FML and once on predisnole, in conjunction with opathanol and catacrom.
The inflammation came back immediately each time I stopped using the steroid drops. Disappointing but not surprising, as they just help to manage inflammation, they do not cure it.

That is why some of the doctors I have seen have recommended I use steroid eye drops long term to control my inflammation but I have refused each time because I am afraid of the side effects.

Have you tried temporary punctal plugs? If not I would recommend you do so, as when I had them inserted, my eyes became very itchy due to allergens getting trapped so I had to have the removed. If I had had them permanently cauterised it would have been a disaster. I am surprised your doctor suggested cauterisation considering you have allergies.

[Matt0029]

Thanks I've had the silicon plugs in before. I could try these again. My left eye I can no longer have a plug as the duct was cut open to remove one that was pushed my too far in. My eyes never itch so not sure if I have a allergy? But had the papillary.

[Matt0029]

I think the predisnole O.5 has been the only thing that has cured me. Was on it for 2 months when I started on ikervis. My eyes were just about perfect on that.

[Alix]

I see, are you still on Ikervis now?

[Guest]

I have been on 2 courses of steroid drops which lasted 6 weeks each, once on FML and once on predisnole, in conjunction with opathanol and catacrom.
The inflammation came back immediately each time I stopped using the steroid drops. Disappointing but not surprising, as they just help to manage inflammation, they do not cure it.

That is why some of the doctors I have seen have recommended I use steroid eye drops long term to control my inflammation but I have refused each time because I am afraid of the side effects.

Have you tried temporary punctal plugs? If not I would recommend you do so, as when I had them inserted, my eyes became very itchy due to allergens getting trapped so I had to have the removed. If I had had them permanently cauterised it would have been a disaster. I am surprised your doctor suggested cauterisation considering you have allergies.

I’d try to avoid long term steroids. HOWEVER, if all else fails, you don’t have jumps in IOP and you can get preservative free steroids compounded...I think that’s way better than allowing the inflammation to run wild. Sadly, we’re all in a bad position. If we do nothing, inflammation destroys our glands and tissue. You take drugs, you risk side effects. Not mild ones either, blindness is not a better option to pain. So again, the situation were in us very very difficult. Have you tried scleral lenses yet? Clearly if you could keep inflammation down by at least controlling exposure, the allergic portion would be easier to control.

Good luck, we are all making choices we don’t want to make. It’s the nature of this disease sadly.

[Alix]

Hi Dowork123 thank you the last doctor I saw said I should try out scleral lenses, however the one before that said he didn't recommend them at all as they would just be ******g the problem and he has seen many people with corneal complications arising from their use so he really put me off.

I was on oral doxycycline but had to stop as I started to get severe skin rashes. I am now on Azyter eye drops but they sting like hell and are making my eyes even more bloodshot. I am on a one month course of this so I will stick it out, and if this doesn't work, I will either go on Ikervis which I have a prescription for, or try scleral lens.

As you say I think alot of people on this forum are having to pick the least worst option.

I understand what you are saying about steroids but for me, using these long term really are the last resort, after Ikervis and scleral lens.

[Matt0029]

I see, are you still on Ikervis now?

I am yes. On its own it doesn't control the inflammation enough.

[Matt0029]

I’d try to avoid long term steroids. HOWEVER, if all else fails, you don’t have jumps in IOP and you can get preservative free steroids compounded...I think that’s way better than allowing the inflammation to run wild. Sadly, we’re all in a bad position. If we do nothing, inflammation destroys our glands and tissue. You take drugs, you risk side effects. Not mild ones either, blindness is not a better option to pain. So again, the situation were in us very very difficult. Have you tried scleral lenses yet? Clearly if you could keep inflammation down by at least controlling exposure, the allergic portion would be easier to control.

Good luck, we are all making choices we don’t want to make. It’s the nature of this disease sadly.

Understand what you mean by inflammation destroying our glands. When I was on predisnole and ikervis for about 2 months. My eyes were perfect really I didn't need lubricanting drops as my eyes were producing enough tears. Vision and everything was amazing.

[Alix]

I am yes. On its own it doesn't control the inflammation enough.

How long have you been on Ikervis, and do you think it is helping at least partly to control the inflammation?

[Matt0029]

Around 9months now. So quiet a while. One drop a night. Partly yes well it seemed to be. Or maybe it was just the predisnole things slowly went down hill after finishing that.

[Guest]

Around 9months now. So quiet a while. One drop a night. Partly yes well it seemed to be. Or maybe it was just the predisnole things slowly went down hill after finishing that.

I tapered Alrex (.3% lotoprednol) into restasis for about two months. On the steroid, I felt good. Once it tapered off completely, I slowly started getting dry again. When I went into the doc after 5 months on restasis, he said, quit taking it, it’s not working. My Schirmer was about 3mm in both eyes. Once I stopped, I realized I was actually allergic to it. So of course, it was actually causing more inflammation. I felt so much better once I quit. I actually haven’t put commercial eyedrops in for 4 days now. I’m only using serum. That’s been another huge help. I don’t need gel at night anymore, again, it was probably causing inflammation. Less is more for me anyway.

[Matt0029]

Interesting point. Is restasis/ikervis ment to increase schirmers test score?