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Questions about dry eyes
Hi,
Couple questions. I just want to know if I have any reason to be worried or if I can put my worries to rest. I am extremely afraid of losing my vision. Each day I have to pry my eyes open and they are red and completely inflamed. They get better throughout the day but then the cycle repeats the next day. I have yet to find something to protect them during the night- ointments irritate them more, Tranquil eyes caused too much pressure on my lids and were uncomfortable to sleep in. Will this eventually lead to scarring and vision loss? I had Lasik two years ago and have had 20/20 vision for the first time and I'm afraid of losing that. Also, what can I do to protect them during the night when they seem to be the worst? My second question is - can applying drops incorrectly lead to keratoconus? I read this in a comment somewhere but have never heard of that before.
Thank you for your time!!
Couple questions. I just want to know if I have any reason to be worried or if I can put my worries to rest. I am extremely afraid of losing my vision. Each day I have to pry my eyes open and they are red and completely inflamed. They get better throughout the day but then the cycle repeats the next day. I have yet to find something to protect them during the night- ointments irritate them more, Tranquil eyes caused too much pressure on my lids and were uncomfortable to sleep in. Will this eventually lead to scarring and vision loss? I had Lasik two years ago and have had 20/20 vision for the first time and I'm afraid of losing that. Also, what can I do to protect them during the night when they seem to be the worst? My second question is - can applying drops incorrectly lead to keratoconus? I read this in a comment somewhere but have never heard of that before.
Thank you for your time!!
This is a previous post on dry eyes. READ THIS FIRST:
General Information on Dry Eyes-Now known as Tears Dysfunction Syndrome.
Have a Schirmer test done.You can also ask for a tears osmolarity test. Greater than 300 is dry eyes. I'm assuming from your posting that you have tried both preserved and unpreserved artifical tears, gels or lubricating ointments at bedtime, environmental modification, etc. Don't discount eye drops. There are over a 100 different brands of artificial tears and they can't all be lumped together. Sometimes one will find the perfect drop. Because the problem is so prevalent the pharmaceutical companies are coming out with new products all the time. Some of the newest are Systane preserved and unpreserved drops and Optive drops. Eye drops for dryness are classified as preserved drops (individual vials that must be used within 24 hrs), preserved drops, gels and ointments. The preserved drops are more expensive and usually only help the small percentage of people that are really allergic to preservatives. Gels and ointments are normally used at night since regular tears won’t last all night. There is also an over the counter spray for dry eyes called “Tears Again”. Tears may need to be used as often as 6 times/day.
If you took Restasis you have used the best prescription medication. A "trial" of Restasis is a minimum of 3 to 4 months of therapy using one drop in each eye twice/day. Because of the way Restasis works, it takes two months to "start working". I have found that many patients use it for a few weeks then conclude it won't help. The medication often stings when therapy is begun--it usually gets better by week three or your Ophthalmologist (EyeMD) can prescribe a mild steroid drop for a couple of weeks. If you did not take for 8 weeks you need to restart therapy. Improvement often continues for up to 6 months.
If you have tried tear duct plugs you should have had all for tear duct openings (puncta) plugged with a permanent plus (not a disolving one). Usually just the lower lids are done with mild dry eyes. If your problem is as bad as you say, you and your ophthalmologist should discuss permanent closure of some or all four of the tear duct openings with cautery.
Be sure to try Nature’s Tear’s Eyemist a spray for dry eyes that works for many people. It is available without a prescription. http://www.naturestears.com/
Additional things that can help include a diet rich in fatty fish (eg salmon, sardines, etc). Fish oil taken by mouth usually 2 to 4/day has been show to help some patients. In addition there are non-prescription pills for dry eyes available at most major drug stores or by direct order from the companies. Thera-tears formula for dry eyes is probably the most widely used. You can use any search engine to pull up the websites of the companies that see these.
Ask your ophthalmologist (Eye MD) about Lacriserts. These were unavailable for several years and are now on the market by Aton Pharma. They are very tiny pellets of hydroxypropyl cellulose that are placed between the eye lid and the eye and slowly dissolve over 24 hours coating the eye with a moisturizing coat. They are a prescription medication.
In dry eyes associated with corneal damage, moisture retaining goggles are used for sleeping. Be absolutely certain you do not sleep under a fan, heating outlet or situation where air moves over your face during sleep. Make certain you home is humidified in the winter, put a humidity gage in the bedroom. If you cannot maintain a 50-60% humidity put a room humidifier in the bedroom. Run the A/C or heater of your car through the vents on your feet not in your face. Long car or plane trips put your tears in every couple of hours.
If you are menopausal or post-menopausal be sure you and your gynecologist maintain optimal hormonal balance. (Many women with dry eyes have dry mouth and dry vaginal canal). If you have joint pain have that evaluated to be sure you don't have Sjorgren's syndrome. Many medications eg antihistamines can make dry eye worse. You might review your medications with your ophthalmologist.
If you reach a point of exhausting all the above see an ophthalmologist that specializes in "Cornea and External Disease". This is their special area of expertise. A final new treatment that they can often do is “Autologist Platelete-rich plasma” therapy. This uses eyedrops made out of your blood products. (reference Ocular Surgery News: November 1, 2007 page 46 lead author Jorge Alio MD.
Keep digging and moving forward. I suspect you have not exhausted all the ways you can be helped.
General Information on Dry Eyes-Now known as Tears Dysfunction Syndrome.
Have a Schirmer test done.You can also ask for a tears osmolarity test. Greater than 300 is dry eyes. I'm assuming from your posting that you have tried both preserved and unpreserved artifical tears, gels or lubricating ointments at bedtime, environmental modification, etc. Don't discount eye drops. There are over a 100 different brands of artificial tears and they can't all be lumped together. Sometimes one will find the perfect drop. Because the problem is so prevalent the pharmaceutical companies are coming out with new products all the time. Some of the newest are Systane preserved and unpreserved drops and Optive drops. Eye drops for dryness are classified as preserved drops (individual vials that must be used within 24 hrs), preserved drops, gels and ointments. The preserved drops are more expensive and usually only help the small percentage of people that are really allergic to preservatives. Gels and ointments are normally used at night since regular tears won’t last all night. There is also an over the counter spray for dry eyes called “Tears Again”. Tears may need to be used as often as 6 times/day.
If you took Restasis you have used the best prescription medication. A "trial" of Restasis is a minimum of 3 to 4 months of therapy using one drop in each eye twice/day. Because of the way Restasis works, it takes two months to "start working". I have found that many patients use it for a few weeks then conclude it won't help. The medication often stings when therapy is begun--it usually gets better by week three or your Ophthalmologist (EyeMD) can prescribe a mild steroid drop for a couple of weeks. If you did not take for 8 weeks you need to restart therapy. Improvement often continues for up to 6 months.
If you have tried tear duct plugs you should have had all for tear duct openings (puncta) plugged with a permanent plus (not a disolving one). Usually just the lower lids are done with mild dry eyes. If your problem is as bad as you say, you and your ophthalmologist should discuss permanent closure of some or all four of the tear duct openings with cautery.
Be sure to try Nature’s Tear’s Eyemist a spray for dry eyes that works for many people. It is available without a prescription. http://www.naturestears.com/
Additional things that can help include a diet rich in fatty fish (eg salmon, sardines, etc). Fish oil taken by mouth usually 2 to 4/day has been show to help some patients. In addition there are non-prescription pills for dry eyes available at most major drug stores or by direct order from the companies. Thera-tears formula for dry eyes is probably the most widely used. You can use any search engine to pull up the websites of the companies that see these.
Ask your ophthalmologist (Eye MD) about Lacriserts. These were unavailable for several years and are now on the market by Aton Pharma. They are very tiny pellets of hydroxypropyl cellulose that are placed between the eye lid and the eye and slowly dissolve over 24 hours coating the eye with a moisturizing coat. They are a prescription medication.
In dry eyes associated with corneal damage, moisture retaining goggles are used for sleeping. Be absolutely certain you do not sleep under a fan, heating outlet or situation where air moves over your face during sleep. Make certain you home is humidified in the winter, put a humidity gage in the bedroom. If you cannot maintain a 50-60% humidity put a room humidifier in the bedroom. Run the A/C or heater of your car through the vents on your feet not in your face. Long car or plane trips put your tears in every couple of hours.
If you are menopausal or post-menopausal be sure you and your gynecologist maintain optimal hormonal balance. (Many women with dry eyes have dry mouth and dry vaginal canal). If you have joint pain have that evaluated to be sure you don't have Sjorgren's syndrome. Many medications eg antihistamines can make dry eye worse. You might review your medications with your ophthalmologist.
If you reach a point of exhausting all the above see an ophthalmologist that specializes in "Cornea and External Disease". This is their special area of expertise. A final new treatment that they can often do is “Autologist Platelete-rich plasma” therapy. This uses eyedrops made out of your blood products. (reference Ocular Surgery News: November 1, 2007 page 46 lead author Jorge Alio MD.
Keep digging and moving forward. I suspect you have not exhausted all the ways you can be helped.
1 Comments
No you cannot cause keratoconus by putting in eye drops. What you may have read is that rubbing the eyes hard and often may play a roll in developing K-conus. Be sure you don't sleep under fan or have air moving across your face. in winter use a humifier in your bedroom. Use a quality gel at bedtime both eye examples: genteal gel, systane gel, refresh PM, liquifilm get. Then rinse eyes in morning with warm water and put in your favorite artificial tears. Go on oral omega 3 either fish oil or krill oil (MegaRed) Permanent loss of vision from dry eyes in a young person is extraordinarily rare
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