Questions From Follow Up Visit Today

[dnew85]

Well, I went in to my appointment extremely optimistic. That is more than I can say for the way that I left. I asked him to concentrate on my right eye since it is the one that is bothering me most(inflammation and pain). He said it looks like Dry Eye/MGD/Conjunctivitis (all together). I asked about ANY surgery or laser treatment that could eradicate the inflammation in my right eye. He said to just be patient. He started me on doxycycline 100mg/day and an ointment called Bacitracin Zinc and Polymyxin B ointment at night. I have read some of the doxy posts but have not seen anything about the ointment. Anyone had significant success and if so how soon did you see a difference???

My second question is there is noted inflammation in your LASIK evaluation for your right eye and no one performed a schirmers test on you, how can you be sure you are a "good candidate"?

Did anyone else that had LASIK not have a Schirmer's Test prior to the procedure?

[dianat]

I didn't...and I was contact lens intolerant. I'm not surprised they do not do this test prior to refractive. It's really not a very reliable test.

[dnew85]

MGD and TBUT

I have read that MGD presents with a fast TBUT. If that is true then why have me on doxy etc. My TBUT was >20 seconds. 5mm or below schirmers in right eye though. Am I on the right track???

[Rory]

More and more Drs simply dont use Schirmer tests anymore as they are apparently so crude and unreliable.....

[Rebecca Petris]

Personally I believe that some of the 'reliability' issue is simply the gross inconsistencies in the method use to perform the test. With, or without anaesthetic? Are they measuring before the anaesthetic drops have drained or without blotting them (meaning the strip soaks up drops not tears..) etc. With these kinds of variables of course the results will vary, even without considering time of day, environmental factors etc.

Same basic principle applies to dark-adapted pupil measurements before LASIK. I've been measured anywhere from 5.5mm to more than 7.5mm - no small discrepancy, when for purposes of surgical planning it may make the difference between having acceptable or unacceptable night vision.

With pre-lasik testing though the point is to get a thorough evaluation for dry eye and related conditions, however they choose to manage the specifics of it.

[dnew85]

TBUT and MGD/Rosacea

Wouldn't a short TBUT support MGD/Rosacea diagnosis? During my last visit my TBUT was greater than 20 sec in both eyes. Thanks.

[Rory]

Wouldn't a short TBUT support MGD/Rosacea diagnosis? During my last visit my TBUT was greater than 20 sec in both eyes. Thanks.

No it wouldnt. It would depend in what environment the test was done....and what environment you had been in previously.

Tears evaporate much more rapidly in dry conditions.

It is perfectly possible to have MGD and a perfectly normal TBUT if you are in humid conditions.

[Rebecca Petris]

Wouldn't a short TBUT support MGD/Rosacea diagnosis? During my last visit my TBUT was greater than 20 sec in both eyes. Thanks.

This is a really, really good question.

I think we should query Dr. Holly about #5 of his 10 Fallacies. It could get very interesting as well as controversial!

[LasikLady]

I was not given a schimers test prior to lasik. I assume/hope/pray that my surgeon was looking for signs of dry eye when he was examining my eyes pre surgery. I wore contacts very comfortably. Had no signs of dry eye that I knew of and yet here I am 15 months post surgery with dry eyes. I don't think they really can tell who will get dry eye from lasik. I think it's a shot in the dark.

I guess that isn't really what the original post was about. Sorry about my 2 cents!!

[indrep]

[QUOTE=Rebecca Petris;24215]
Same basic principle applies to dark-adapted pupil measurements before LASIK. I've been measured anywhere from 5.5mm to more than 7.5mm - no small discrepancy, when for purposes of surgical planning it may make the difference between having acceptable or unacceptable night vision.

QUOTE]

If the test is performed before 60 seconds in a room without windows, and I think 5 lumens of light, that could explain the difference. I have seen many eyes that in the first 50 seconds dilate minimally and then in 10 seconds go to 8 -9 mm.