Low tear production and/or an allergy causing inflammation

[Matt0029]

Thank you .I have never tried cold compress. I will give it a go.

[Meibum Ian]

Thank you. Any ideas of the best way to treat this form of dry eye? I will discuss again with my doc.

Things that control inflammation..

Ikervis, Xiidra, Serum drops, Steroids, Doxycycline, Cold compress.

Lacrimal gland PRP injection if the gland is damaged - probably not in your case as you were better with inflammation under control.

[Matt0029]

Inflammation affecting lacrimal gland function is definitely "a thing"

Thank you. Any ideas of the best way to treat this form of dry eye? I will discuss again with my doc.

[Meibum Ian]

Thank you. When I was on the predisnole my eyes were producing loads of tears. They were moist all day. This kind of says that inflammation is effecting my lacrimal gland? It's strange.

Inflammation affecting lacrimal gland function is definitely "a thing"

[Matt0029]

Thank you. When I was on the predisnole my eyes were producing loads of tears. They were moist all day. This kind of says that inflammation is effecting my lacrimal gland? It's strange.

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

Yes, that’s the exact function of the drug as per the manufacturer. To reduce inflammation in the lacrimal gland so that tear production can increase. Remember, it only helped 15% of the people in the study using it. I mean, I Feel that artificial tears alone would help more than 15% of the people using them.

[Matt0029]

I thought after 6 weeks it had started to work but I think it was just the predisnole.

[Matt0029]

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

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]

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.

[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]

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.

[Matt0029]

I see, are you still on Ikervis now?

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

[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.

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.