Dry Eye Syndrom

[gma2]

I went to the eye doc last week with what I thought was something in my good eye (background: I went blind in my left eye from a stroke in 2003, so I only have the one good eye) He found a tear in the cornea with debris under it - got most of that out, quit after a lengthy time of  "too much on me for now'' sent me home with prescription drops.

I went back yesterday for a checkup to see if the swelling went down, the debris was cleared out and the tear in the cornea had healed up, and he said it is still very irritated in there and not healing like he'd like to see, and he said I have Dry Eye Syndrome, so now I have to put the prescription drops in every 6 hours and some OTC drops every hour or two inbetween that (I set a timer, but I usually can feel it b4 the timer is done).  I have to take care of this as it is the only eye I have left. I would think my tears would be enough (I am so scared). He said it could be related to my thyroid issues, but he wasn't sure.

I am learning to blink more while on the computer, spending less time on the computer, etc - my question really is two-fold: Any dry eye syndrome suggestions for me? and then there is this:

I have what everyone tells me (can't get to the docs - no ride) sounds like positional vertigo - I tend to agree after research on it. (It's like my head moves and then the insides of my head catch up a second later)

Anyway, it might be coincidence, not sure, but the eye and the weird sensation in my head started about the same time, looking back on it all.

So that is the second half of this:

Is there anyone who has been through either or, or both together, or just simply knows what to do. I know I need to get to my docs (my home health people are working on that...supposedly - whole nuther story, that) but I really am scared about this and although I'm usually tougher than this, I don't think it is irrational fear.

Anything at all would be appreciated. Thanks ahead of time.

[John C Hagan III, MD, FACS, FAAO]

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[cgatman]

Go to your Opthomologist.  Request that he/she see if you have ocular rosacea.  It can cause severly dry eyes.

Check out this article

http://www.dailymail.co.uk/health/article-2358570/Sore-bloodshot-eyes-A-hidden-skin-problem-blame.html

Hopes this helps anyone who also suffers from this horrible eye disease.

[gma2]

I found this for the goggles you suggested (are you familiar with it and if so is it what you were talking about?): tranquileyes CHRONIC DRY EYE kit - Includes Tranquileyes goggle, 2 spare foam, cleanser, washbag, travel sack

Alcon Systane Lubricant Eye Drops  is what I found for lubrication and

GenTeal Lubricant Eye Gel Severe Dry Eye Relief (this one says: Preservative free in the eye with GenAqua.)

Are these two what you might suggest?
Regarding the goggles: would I still use the gel at night, or are the googles enough? or would the gel alone be enough and no need for the goggles then?

There are five corneal/external disease MD's listed within a 10 mile radius (my comfort zone for traveling) so that turned up a nice selection for me. I think it is imperative for me to be seen, as this continues on with no relief. Having that site info really saved me some work.

I am also using a room humidifier in my office here and I am not using the overhead light -a more diffuse table lamp has helped considerably for computer time.

I will continue on with the 4-sight since that is what I have; and the Omega's as well.

I think that is it until I can get in. My primary care doc would also like me in for the other physical symptoms (vertigo(?), headache and nausea so when I can figure out the ride issue, soon I hope, I will get in for the labs and some physical tests he needs to do.

What can I say? You have been an awesome resource of information for me. It is all so very much appreciated.
I Thank you.
gma2

[John C Hagan III, MD, FACS, FAAO]

Consider seeing an Eye MD ophthalmologist that specializes in corneal and external eye disease. Find one at www.aao.org

JCH MD

[gma2]

Well, that's news as well - He gave me plenty so that makes me wonder. I do not believe that was mentioned to me. I will be calling him today because this is worse and worse as time is going on here and I am getting very little relief from pain. I have blurred vision as well as a crazy dizziness with movement going on.

Your info was invaluable to me - I really appreciate it.
gma2

[John C Hagan III, MD, FACS, FAAO]

Tobradex is a strong steroid containing medication plus a strong antibiotic. It should not be used for long in the treatment of dry eyes.

JCH MD

[gma2]

Wow. Thank you so much. Priceless information.

I am using Tobradex right now with Visine Tears inbetween (had it on hand). I am also taking Dr Earl Mindrell's 4-Sight, and  Carlson's Super Omega*3 Fish Oil Concentrate 1000 mg x's 1 week.

My eye doc suggested the Systane (I have it on my shopping list - people shop for me) and preferred I look into Ocuvite or Macugen vs the 4-Sight (although he said 4-sight was fine too - missing Zinc which I get some but not enough in a liquid supplement OsteOmegaCare -for Osteoporosis, DDD and DDJ).

I printed off your response for further and more thorough study, and will implement your suggestions on the humidity, air conditioning, etc.

Thank you!
gma2

[John C Hagan III, MD, FACS, FAAO]

General Information on Dry Eyes

a Schirmer test of zero indicates that you have severe 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 compies 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 8 weeks 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.

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.

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.

JCH MD