Managing severe dry eyes + successful cataract surgery!

[Hokucat]

https://www.dryeyestories.com/new-bl...ous-deficiency

Wanted to provide an update to my above Dry Eye Story I submitted several years ago, to give further hope to those of you struggling. Some of you in this forum may not be aware of these stories Rebecca and Aidan have compiled from several members.

I’ve continued managing my dry eyes after those 8 years of severe dry eyes, mainly by following the diet that works for me, limiting use of electronic devices, and being consistent with my daily protocol of serum tears, lid scrubs, EyeEco night goggles, drinking lots of water, and Xiidra. I no longer need sclerals and rarely use OTC eye drops for dry eyes.

I also had successful cataract surgery almost one year ago! I had fairly early cataracts, possibly Prednisolone eye drops on and off several years to treat my dry eyes was a contributor. I delayed surgery as long as I could, fearing it would cause severe dryness again, but my vision got so bad from worsening cataracts combined with my high prescription, I had to do it. My cataract doctor, who is my general ophthalmologist and also treats me for dry eyes, increased my serum tears to every 2 hours, in the weeks leading up to surgery, and continuing afterwards. I think this really helped.

I did have post-surgery inflammation, likely related to my dry eyes and/or other eye issues. This required several more weeks than normal using the various post-surgery drops (steroid, antibiotic, and non steroidal anti-inflammatory) that contain the BAK preservative we dry eye patients try to avoid, in addition to another BAK drop. I do think constantly using serum tears during that time helped protect my eyes and the incisions to heal. So it all worked out and am very happy with the result.

Due to my dry eyes and other eye issues, I was not a candidate for multifocal intraocular lenses (IOLs) that provide distance, intermediate and near vision. So my cataract doctor recommended the Extended-Depth-of-Focus (EDOF) IOLs, which provide both distance and close range vision. Typically dry eye patients have to get monofocal lenses, which only provides distance vision and requires glasses for reading and intermediate vision. With EDOF lenses, I have great distance vision, and can read most printed materials, my phone, and computer screen without glasses. I do need reading glasses if the print is very small and/or the lighting is dim, but that’s minor compared to my situation before.

I know many of us suffering from severe dry eyes have worried about cataract or any eye surgery worsening our condition. I hope this update and information about being able to have a positive outcome from cataract surgery sometime down the line, despite years of debilitating dry eyes, was helpful.

[Aidan]

Hi Hokucat,

Happy to read your cataract surgery was a success. We are getting more and more questions from people in the same boat (delaying surgery fearing it will make the dry eye worse). I'll think about your post next time it comes up. So glad to hear you are managing well! Thanks as always for your contributions to the forum!

[Hokucat]

Thanks Aidan! Happy to share my experience with cataract surgery in hopes it can help others. I can imagine it would be a common fear for all us dry eye sufferers. I did have some anxiety leading up to the surgery, but my doctor kept telling me not to worry so much, as she and my retina specialist (I also have a retina condition which makes cataract surgery riskier as well) had taken steps to mitigate potential problems.

I do want to add that it’s better not to wait until the cataracts get too bad before deciding to have surgery. This is because if the cataract is too mature (large and/or thick), it’s more difficult to remove and the surgery takes longer, causing more stress to the eye. This is what happened to me, my right eye’s cataract was farther along than my left. So my right eye took ~15 minutes longer to remove the cataract, and I had a lot of inflammation and corneal edema post-surgery in this eye, requiring me to take all those post-surgery drops with the BAK preservative several weeks longer than normal. I should have had cataract surgery 2-3 years ago when I was told I was ready to get it, but the pandemic and my fears delayed it.

[orange86]

HI Hokucat , do you have all 4 puncta occluded? How dry are your eyes currently?

[Hokucat]

orange86 , I used to have silicone plugs in my lowers for several years and tried uppers for a short time. I found I didn’t need them anymore, but it was because of an incident a few years ago when one of the lowers fell down into the duct and I got an infection!

Fortunately my doctor was able to remove the plug without surgery - she said if it got stuck inside I would have needed major surgery to remove it. So she also took out the lower plug on the other eye to be safe, and I didn’t have any plugs for a few months, to let the ducts recover. I was very worried to be without plugs. Eyes definitely felt a little drier initially, but after a few weeks it wasn’t so bad or my eye got used not having them. She later put in dissolvable lower plugs which only last 1-2 months. I think I had them replaced once, but decided to try not replacing them right away the next time, since my eyes seemed to adjust when I didn’t have any plugs those few months after the infection. When they dissolved, again my eyes felt a little drier, but after awhile they seemed to adjust. So I never had the plugs replaced and it’s fine without them. I’m sure given I’ve been able to manage my condition better these last several years so I have a little tear film now (vs. virtually none before), was a contributing factor.

Doctors tend not to plug uppers as often because I’ve been told lowers are doing 90% of the work, uppers only 10%, but several people in this forum have said also doing uppers made a noticeable difference. Do you have both, and if so how is this working for you?

[Ursula]

Hi Hokucat: My right eye waters all the time. I was thinking of asking my doctor for dissolvable plugs. I’m assuming one would call watery eyes, resultant from dry eye disease, as evaporative tears.(?) Were your eyes watery…was that the reason you sought plugs?

[Hokucat]

Ursula, plugs are one of the initial treatments for dry eye symptoms. It was one of the first things after eye drops that my very first eye doctor prescribed, and I had them for at least 10 years. It’s usually a simple process to slip them in, so I think it’s a good idea to see if it provides some relief, especially the dissolvable plugs. Treating the symptoms is important so you can get some immediate relief and sanity. Hopefully you will find treatment(s), diet, etc. that addresses the underlying cause too, but that can take some time.

My eyes were very bone dry for many years. But they did get watery, to the point where it would sting, especially when I was using electronic devices. This paragraph from WebMD on why people with dry eyes get watery eyes is a good explanation:

“Sometimes, dry eyes create too many tears. This confusing condition is called reflex tearing. It happens because the lack of moisture irritates your eye. It sends a distress signal through your nervous system for more lubrication. Your body sends a flood of tears to try to make up for the dryness. It’s a lot like what happens when you get sand in your eye and it runs. But these tears are mostly water, so they don’t act like normal tears. They can wash debris away, but they can’t coat your eye’s surface.”

As far as evaporative tears or evaporative dry eye, this usually means one does not have enough oil from their meibomian glands to mix with the tears produced from their aqueous glands. The oil is what helps keeps the tears on the eyeball. Little or no oil and the tears can evaporate in a matter of a few seconds, which leaves your eyes vulnerable to air, wind, erosions, infections, etc.

Do you know if you are aqueous deficient, have meibomian gland deficiency, or both?