Schirmer Test and glands are fine but lipid layer thin

[jack1988]

Hi guys,

So, my right eye has had bouts of dryness ever since Strabimus surgery 9 years ago. I have been to see a dry eye specialist and they have told me that my Schirmer tests came back fine - right eye 20mm. and my glands are fine with no sign of bleph. However, my lipiview scores on my right eye is 50, which means it is thin.

Have you ever come across this before, Aqueous layer and glands are good but lipid layer still thin? Don't know how to tackle it as I don't need to compress and maintain eyelid hygiene and glands are fine and my Schirmer tests are good.

Which eye drops would be best for thin lipid layer, Hypromellose?

[deep_dry_eye]

Schirmer is a test that has high variance, and should have very small clinical significance. A negatve Schirmer test does not imply one does not have dry eyes/MGD.

Yes, your glands can be intact, but produce little oil. You need to find the root cause of the disease, it is most likely inflammation. Good starting points is to do IPL (which can help promote secretions), Xiidra and Reatasis (which can help reduce/control inflammation).

[jack1988]

Schirmer is a test that has high variance, and should have very small clinical significance. A negatve Schirmer test does not imply one does not have dry eyes/MGD.

Yes, your glands can be intact, but produce little oil. You need to find the root cause of the disease, it is most likely inflammation. Good starting points is to do IPL (which can help promote secretions), Xiidra and Reatasis (which can help reduce/control inflammation).

The doctor said the oil produced was okay, nice and clear. I am on Restatis, but it seems like a weird thing to be on when my issue is a thin lipid layer and not aqueous deficiency

[deep_dry_eye]

The doctor said the oil produced was okay, nice and clear. I am on Restatis, but it seems like a weird thing to be on when my issue is a thin lipid layer and not aqueous deficiency

Restasis treats inflammation, if the inflammation causes MGD, Restasis will help the MGD.

Just because oil is nice and clear does not imply you don't have MGD, e.g., MGD can also cause oil volume issues. The next step for you imo is to give IPL a try, You should also double down w/ Xiidra as well, esp if you find the Restasis ti help.

[jack1988]

Restasis treats inflammation, if the inflammation causes MGD, Restasis will help the MGD.

Just because oil is nice and clear does not imply you don't have MGD, e.g., MGD can also cause oil volume issues. The next step for you imo is to give IPL a try, You should also double down w/ Xiidra as well, esp if you find the Restasis ti help.

Thanks, I will mention IPL. We don't have Xiidra in the UK.

[Alix]

Do you take omega 3 supplements and eat fish? Not that it’s guaranteed to work but if your lipid layer is thin you need to do something to improve the quality of the oil coming out of your glands. Did the doctor have any suggestions as to what’s causing the thin lipid layer? No amount of eye drops is going to fix this. You have to treat your problem from within.

[jack1988]

Do you take omega 3 supplements and eat fish? Not that it’s guaranteed to work but if your lipid layer is thin you need to do something to improve the quality of the oil coming out of your glands. Did the doctor have any suggestions as to what’s causing the thin lipid layer? No amount of eye drops is going to fix this. You have to treat your problem from within.

Hi,

I had ocular surgery back in 2010 and I've had bouts of dryness ever since. My glands are all present and correct and the oil is clear according to Mr Tam.

[Alix]

If the lipid layer is thin, then surely it means there is not enough oil coming out of the glands. The problem looks like quantity not quality.
What did he say you should do?

[jack1988]

If the lipid layer is thin, then surely it means there is not enough oil coming out of the glands. The problem looks like quantity not quality.
What did he say you should do?

I can't remember. It was two years ago when i went. My glands are fine with no inflammation. The ocular surgery has destabilised my tear film. He didn't have an issue with my glands. I need to go back to him

[TARYN]

Hi Jack, It sounds like your strabismus surgery might have caused damage to your conjunctiva which is causing a disruption of the tear flow and tear film instability. I had problems after a blepharoplasty a cosmetic procedure. I developed a loose or wrinkled conjunctiva which is known as conjunctivochalasis. I had burning and redness which eye drops and compresses were not giving me any relief. I had a conjunctivoplasty with amniotic membrane which helped to have no scarring and a quick recovery. I do not have burning or redness any more. My eyes are clear and comfortable. You can ask your doctor if the strabismus surgery could have caused damage to your conjunctiva and if the procedure I had might help you.

[jack1988]

Hi Jack, It sounds like your strabismus surgery might have caused damage to your conjunctiva which is causing a disruption of the tear flow and tear film instability. I had problems after a blepharoplasty a cosmetic procedure. I developed a loose or wrinkled conjunctiva which is known as conjunctivochalasis. I had burning and redness which eye drops and compresses were not giving me any relief. I had a conjunctivoplasty with amniotic membrane which helped to have no scarring and a quick recovery. I do not have burning or redness any more. My eyes are clear and comfortable. You can ask your doctor if the strabismus surgery could have caused damage to your conjunctiva and if the procedure I had might help you.

Hi, i do have scarring on the conjuctiva. I don't have any loose or wrinkled conjunctiva though.

Where did you have your surgery?

[TARYN]

The scarring on the conjunctiva might be interfering with the tears not being able to spread evenly over the ocular surface. I also had a few pinguecula on the other eye which was interfering with the tears being able to spread evenly over the ocular surface. The burning and redness bothered me. The AMT surgery gave me immediate relief. The amniotic membrane helped the surgery to heal with no scarring. I had the surgery with Dr Scheffer Tseng in Miami, Florida.

[jack1988]

The scarring on the conjunctiva might be interfering with the tears not being able to spread evenly over the ocular surface. I also had a few pinguecula on the other eye which was interfering with the tears being able to spread evenly over the ocular surface. The burning and redness bothered me. The AMT surgery gave me immediate relief. The amniotic membrane helped the surgery to heal with no scarring. I had the surgery with Dr Scheffer Tseng in Miami, Florida.

Thanks for this info. I wonder if there are surgeons in the UK that do AMT surgery or the conjuctivochalasis surgery. Never heard of it before.

[TARYN]

Hi Jack, It is one surgery where they remove the damaged conjunctiva or in your case the scarring and they place the amniotic membrane over the surgical area so it will heal quickly with no scarring. You can get in touch with his office and see if he recommends anyone in the UK. Dr Tseng pioneered the surgery so he may have trained some doctors in the UK. Whenever I have gone to his office there always seems to be patients from other countries so he must have an international reputation. His websites are ocularsurface.com and tissuetech.com and biotissue.com

[jack1988]

Hi Jack, It is one surgery where they remove the damaged conjunctiva or in your case the scarring and they place the amniotic membrane over the surgical area so it will heal quickly with no scarring. You can get in touch with his office and see if he recommends anyone in the UK. Dr Tseng pioneered the surgery so he may have trained some doctors in the UK. Whenever I have gone to his office there always seems to be patients from other countries so he must have an international reputation. His websites are ocularsurface.com and tissuetech.com and biotissue.com

can scarred conjunctive cause dry eye/ tear film instability?