Frustrating Dr Appt

[WendyE]

<vent>
Today was my first follow up with the Opt for my dry eyes. He told me my eyes were dry and stinging because of insufficient oil which was caused by my dry skin. He had inserted collagen plugs saying I should see improvement immediately if plugs were going to work for me.

I had questions about this whole dry eye thing as it pertains to me and he persisted in giving general answers to specific questions. Very unhelpful! I wanted to know if I had tear deficiency or oil gland deficiency. Well, says he, 90% of dry eye cases are caused by oil deficiency and that's what I probably have since I have dry skin. I do? Then why do I need to use the acne solutions stuff from Clinique to keep the zits at bay when I'm in my 40's? I've had oily skin since I hit 12! He said he observed my hands were dry last time he saw me and dismissed the fact that I have my hands in gloves all day, wash with harsh soaps and never get manicures.

He didn't want to answer my questions and didn't want to listen to any input I had about my condition except that my left eye has been burning and tearing all week. For that he gave me Alrex drops and wants another follow-up in 10 days.

I asked if there was anything I could about these oil glands (I didn't tell him about the info I've learned here) and he said no, some people think omega 3 supplements will help, but nothing else. He did not recommend any artificial tears or anything else.

The only thing he did today (besides type in a script for the drops) was to drop something on a piece of paper and then touch the paper to my lower eyelids and look at my eyes with the slit lamp and blue light. I am going to assume that was the fluorescein dye since he didn't say. I asked if the tears broke up too fast and he grunted. He said he saw signs of abrasion to the corneas and that's what the drops were for. I asked if the left was worse than the right as it's more symptomatic and he said he couldn't say since they looked the same to him. Then he stood up and I figured my time was up.

I guess I would have to grab him by the throat to get the actual times for the tear film to break up or clearance times. I distinctly felt like my questions were taking up his time and he didn't really want to talk to me at all.
</vent>

Thank goodness for this site! I learned far more from here than I did from the actual Dr treating me.

Now I need to figure out how to get treatment off-base (my husband is retired Air Force) from a more helpful/knowledgeable Dr.

[Silverlady]

Thyroid?

Have you had your thyroid checked lately? Dry skin can sometimes be a symptom of thyroid problems.

Billye

[WendyE]

Have you had your thyroid checked lately? Dry skin can sometimes be a symptom of thyroid problems.

Billye

Yes, I've been hypothyroid for years and on medication for it. My TSH is where it should be.

[elaine]

frustrating dr.s appointment

I've been reading a lot lately about how most doctors decide what the problem probably is within the first several minutes of your appointment. The treatment is planned based on this quick asssessment, without looking at other possibilities, or really listen to the patient. A book came out about it over the summer, what the heck was the name of it?? Written by an internist, I think...
Anyway, I have been to five eye doctors. The first two referred me on after a few visits when they didn't know what to do. I think it's very hard for doctors, I think DES has so many causes, not so many cures, that I wonder if doctors aren't very fond of us, in general. When I went to the last specialist I was so excited about, he decided within two minutes that I had ocular rosacea. He said I had oily skin - it's true I had a pimple on my chin, menopause and all that, but my skin is actually very dry, along with my mouth, sinuses, eyes... I thought he jumped to a conclusion. I was happy someone had an answer for me, but his treatment didn't help, I don't think it was the right answer. I'm cautiously very happy with my new eye doctor.
I'm not sure I've cheered you up, but I really empathize with your unhappiness about your appointment. To be given some time, taken seriously....

[Rojzen]

adult acne and the oily/dry paradox; Dwelle for lipid-deficiency corneal stress

WendyE - -I'm disgusted by the details of your eye doctor visit, though they are all too familiar to me. . .It may, however, be possible to make sense of the doc's insistence that you have "dry" skin, and, therefore, meibomian issues, by rewording what this inarticulate professional had to say. . .

If you have adult acne, and perceptible oiliness of your sebaceous glands, you could have related issues with the meibomian glands, which are not very different from sebaceous glands. . If your doc had been able to explain this better, perhaps he could have conveyed that while your skin may be oily, as in many cases of the adult acne that comes with rosacea, your eyes may be painfully dry because your meibomian glands are sluggish or impacted in the same way as are sebaceous glands that get plugged and pimply, and stop supplying needed oils to your tear layer.

All this said, please consider trying Dwelle for a few months. I have lipid-deficiency of a very extreme nature, and lipid replacement with lipid drops like Soothe has NEVER helped. What HAS helped is the use of Dwelle, which seems to be making up for the corneal damage that lipid deficiency has caused me. . .Dwelle is OTC and does not conflict with anything you might be taking internally. . .

Naturally, serious care of your meibomians should help, too. . .For that, there is the book by Dr. Latkany. . .Tranquileyes may contribute to quieting and restoration of the meibomians, too. . .or at least I suspect this. . .

[WendyE]

Still Learning

I'm still trying to read (and more importantly absorb) here on DEZ and Dr. Latkany's book about everything dry eye. I've tried Thera Tears (ok), Endura (mentholish), Celluvisc (not great), Genteal gel (stings!), & Refresh Liquigel (great!). I've started warm compresses and lid cleaning. I am doing what I can and would like a Dr who will do more than tell me nothing can be done and hand me eye drops.

Right now, I feel like I know more than my Dr and that can't be right!

[Rojzen]

OK to know more

So true, WendyE! that you do, in fact, know more about many aspects of dry eye therapy than does the average doc. . .My eye doc last week explicitly told me that I know more about the action of various OTC products than do the majority of corneal specialists. . .While that's flattering, the situation requires action, so that just as you say, our specialists get more knowledgeable than we are. .

That said, I don't think we can wait for this, and count on our doctors to hand us the smartest eye drop. For years, all my docs had, by way of samples, was Refresh, because Allergan drug reps essentially lived at their offices. Then, when Systane came out, suddenly the only drop doctors handed out, to me, at least, was Systane. . .Apparently, Alcon had done a great job of visiting and plugging. . .

Now, with Soothe and Endura (and possibly the Refresh "Complete" product) being the only popular products with "lipids" in them, if a doc is smart enough to diagnose MGD, he/she will almost certainly push these products to the patient. . .but only because the packaging references lipids/oils. . .

In my experience, this sample-handing/recommending behavior is superficial and has no science behind it. I'm sure that when Hypotears and Muro were the only products around, doctors told patients that hypotonic tears are a must. . .Nowadays, doctors never give out these products, but that's not because hypotonicity has been discredited in the marketplace (though it has, by Dr. Holly!); it's because new products that are not hypotonic have hit the scene, and are more fashionable. . .

I say all this, WendyE, to encourage you to make your own choice of OTC drops, within the parameters of what you know about your disorder. No doctor is likely to know or care to know anything about high oncotic pressure drops, but if you study up on these (see Dr. Holly's postings here), you may arrive at a reason-based decision to try the Dr. Holly drops. There is certainly more science behind them than appears ever to have been undertaken in the development of the commercial stuff out there. . .

[Rebecca Petris]

In my experience, this sample-handing/recommending behavior is superficial and has no science behind it. ....Nowadays, doctors never give out these products... it's because new products that are not hypotonic have hit the scene, and are more fashionable. . .

At the risk of sounding like a total cynic (if I have to have a label I prefer "realist" ), I would personally say that this susceptibility to what's fashionable in artificial tear 'science'/marketing is pretty nearly the BEST case. It means a doctor feels there might actually be a difference between one eyedrop and another.

Much more commonly, the doctor, or his/her technician, will hand you what's in the sample drawer. Period. Which is why Refresh (Allergan) and Systane (Alcon) are the only "recommendations" most patients get unless it's a doctor that takes a little more interest than that AND is fortunate enough to be a marketing target for some of the other companies. (It helps to be in a big practice in a major metro area.) Some of them will have a limited supply of Soothe, TheraTears, or Visine PureTears for example. But artificial tear recommendations are all about samples, and samples are all about marketing dollars.

[WendyE]

Samples and such

I got no samples and no recommendation for lubricant drops at all. Everything I've been doing has been learned here or from Dr. Latkany's book or trial and error. My Dr has done nothing for me that was useful except write my new script for glasses and I could be wrong about that being useful...

From what I've read here, everyone has a different drop or gel or liquigel that they prefer. I've ordered Dr Holly's drops and hope they help more than the Refresh Liquigel. That feels nice for about 30 sec, but it's more than I've gotten from other drops. The only "oily" drops I've tried didn't do much for me at all.

I still haven't gotten my head around tonicity and such, but I'm working on it.

My left eye is burning badly tonight and is about to start tearing... I can tell it's coming