Sensitized Corneas?

[rubyslippers]

My doctor mentioned that even when dry eye gets better, some patients continue to experience the discomfort due to "sensitized corneas". Has anyone had this? Does it ever get desensitized again?

[dianat]

Hmmm....this is interesting. So, according to your doc, once the eye experiences the kind of pain associated with dry eye, it becomes more sensitive to pain even after the surface issue has resolved?

Curiously, us LASIK patients generally complain about our desensitized corneas causing a breakdown in the neural messaging system of eye/brain resulting in a lack of moisture and onset of dry eye symptoms. Unfortunately and very much to my dismay, there seems to be enough nerves present to still feel the endless pain of dry eye.

I guess my lay-person's vote with regard to your doctor is that a patient who is still feeling pain once your doctor says the dry eye has "gotten better", is still suffering from a compromised eye surface. I don't think shrugging off this pain as "sensitized corneas" is a fair thing to do.

[mflores22]

i agree

I guess my lay-person's vote with regard to your doctor is that a patient who is still feeling pain once your doctor says the dry eye has "gotten better", is still suffering from a compromised eye surface. I don't think shrugging off this pain as "sensitized corneas" is a fair thing to do.

I second that thought. It seems that doctors will say anything to get a patient out of the office sometimes. That might be cynical, but it really seems that way sometimes.

Dr. Latkany addressed the idea of 'ghost' dryness in his forum. I believe he considered the theory curious and interesting, but he didn't believe it was possible. My impression is that 'ghost' dryness or oversensitive corneas are just a theory, not a fact proved beyond a reasonable doubt by scientific method.

[indrep]

The Dry Eye Workshop has acknowledged dry eye begins with Hyperosmolarity of the tear film. So if your tear film QUANTITY looks good from a tear break up time or Schirmer test but the osmolarity is still elavated then your brain is still getting signals of dryness. So it is possible that in the healing process your tear film is getting better but the osmolarity has not returned to normal "isotonic" makeup. It, by most standards, is a 90-180 day process.

[rubyslippers]

Thanks for your replies. I am learning so much. My eye doctor says that no matter what he sees or doesn't see, he treats based on patient symptoms because he believes everyone's pain threshold can be very, very different.

[shells]

Thanks for your replies. I am learning so much. My eye doctor says that no matter what he sees or doesn't see, he treats based on patient symptoms because he believes everyone's pain threshold can be very, very different.

I don't know about this "sensitized" corneas thing, but it is nice that your doctor treats based on your pain. It is hard to find a doctor that listens to you about your pain instead of just treating based on the dryness they see. And we all know that even if our eyes look good through the slit lamp, it doesn't mean they feel good!

[rubyslippers]

I am fortunate to have a very sympathetic doctor who even comes into the office on the weekends for patients if need be. It is the policy of the clinic that they have someone on call 24/7 and usually several who will do this. My doctor wants me to call whenever I have a problem and even gives us his home cell phone!

[mflores22]

The Dry Eye Workshop has acknowledged dry eye begins with Hyperosmolarity of the tear film. So if your tear film QUANTITY looks good from a tear break up time or Schirmer test but the osmolarity is still elavated then your brain is still getting signals of dryness. So it is possible that in the healing process your tear film is getting better but the osmolarity has not returned to normal "isotonic" makeup. It, by most standards, is a 90-180 day process.

Wouldn't the variable you would want to pay attention to in this case is the amount of water in the aqueous layer of the tear film. Less water + same amount of solutes = higher osmolarity? How can you have a normal aqueous layer and an elevated amount of solutes? And if that's the case, how does the eye return to an isotonic state? Is there anything the patient can do to speed this process along? I'd really love a bit further explanation, as my eye doctor said that I have 'no stain' and a somewhat normal Schirmer test, yet I still have a little bit of irritation in the morning and at nights, and I am still mostly contact lens intolerant. (I have blepharitis and ocular rosacea)

[indrep]

Unfortunately allowing more aqueous/water on the ocular surface does not immediately change the osmolarity of the ocular surface. The studies seem to indicate a period of 60-90 days to be able to measure a reversal. So to speed process one would need increased water on the ON the ocular surface for increased periods of time. So more water and less evaporation are the starting points. Then it is a matter of time. Also keep in mind that as we age we make less tears and lipids.