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Back to Square One, 5 years post-LASIK

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  • Back to Square One, 5 years post-LASIK

    Background: LASIK in 2013, immediately had severe DE. My haunch is that I've always had subclinical MGD that became apparent after I became aqueous deficient post-LASIK. After trying almost every drop known to mankind (Restasis, serum tears, etc) and scleral lenses (by Dr. G, which I couldn't tolerate due to sensation and cloudy debris after few hours of wear), I've somehow managed to get by and slowly improve to the point where I can just get by on a good day with little pain. For the past 4 years, I have been able to survive with bilateral lower punctal plugs and no drops. By God's grace, I was able to successfully graduate from medical school even though there were many days where I thought I would have to drop out and be on disability.

    1.5 months ago, my eyes became dryer and more inflamed. My flare ups would usually only last a few days and there was usually an obvious culprit, e.g. new face wash, makeup, etc. This time, there was no obvious cause, but I did start a new job (started medical residency, working 40-60 hours/wk, increased stress, decreased sleep, drafty hospitals). I've never had a flare up last this long. I'm in constant pain (burning, soreness) and my eyes are red. I feel like all the improvement I made over the past 5 years has been erased

    Of course, the emotional suffering and depression directly caused by DES is making everything worse. Before LASIK, I was a very positive/compassionate person who was very ambitious and hardworking. Now, I'm the exact opposite. I hate being a physician where I have to put on a caring face 24/7 for patients when I am distracted with 10/10 pain myself and just wanna cry. I sleep 12+ hours a day when I can to forget about everything, and I'm anxious for the future. I feel terribly sorry toward my husband and family who have to deal with this version of myself. I hate that I did this to myself by getting an elective surgery. Yes, I probably should be on a SSRI, but unfortunately, 'mental illness' is a big no-no in my line of work and could jeopardize my job.

    Today, I saw the optometrist who ruled out corneal abrasion, keratitis, or infection as cause for my flare up. She found that my TBUT was nonexistent, and I had maybe 1 working oil gland in each eye. She said my predominant problem was MGD, and that lipiflow would be helpful. Thankfully, my insurance covers it, but there's a 2+ month waitlist. I am still going to try it because it's free, but I know that many here have not found it helpful. She also said that I should get refitted for scleral lenses since that's about my only option right now for regaining some semblance of normalcy. I am not a good candidate for Xiidra because my type of DE is not inflammatory/autoimmune.

    In the mean time, I am going to start Manuka honey on my lid margins (stings like a ***** and causes redness, but worth continuing for now) twice daily, accupuncture, fish oil 3g/daily, eliminate all inflammatory food from diet including gluten, and use lacriserts to get through the work day.

    Like it is for many here, this forum is about my only outlet. I wanted to chronicle and share my experiences, and hopefully we can all gain a little something to get through these trials.



  • #2
    Hi Hosanna

    Thanks for sharing. What helped me:

    LipiFlow opened all glands -helped about 65%. Some pepole do not find it helpful probably they have other issues or in wrong order??

    pure HOCI lid cleanser, like Aveonva, although all doctors said I did not have (bacterial) inflammation. I have no more watering and discharges. My new stategy: pure HOCI + tea tree oil (for avoid demodex)

    Omega 3, 6/GLA:
    thin the oil (even my omega 3 is almost double than normal). new studies show such combination is more effective than omega 3 alone. Just google GLA, you will find some reports.
    --------------------------------
    Just to sharing something as well.

    Glands: how about other glands, clogged? And oil status, thick?
    Then warm compress/massage are important but not easy to master - it took some months to know the tricks.
    Did doctor show you images of glands/oil? It is important as I got 2 complete different diagnosis in 10 days - two doctors did not show me images.

    make-up: perhaps good to stop if eyes are red etc to avoid harmful chemicals.

    Manuka honey: What are the benefits? Is it bio and safe?

    Stay positive. There are more new treatments available. We can achieve more if we tackle ALL issues in right order, combination and timing.
    Last edited by MGD1701; 15-Sep-2017, 09:28.

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    • #3
      Hi MGD1701,

      Thanks for replying. Good to hear lipidflow helped you. Wow, doesn't the tea tree oil sting your eyes? I occasionally express my own glands, and can see no oil coming out of most glands. Not even white/toothpaste-like stuff. The glands that do express, the oil is clear but slow to secrete. I am going to be more diligent about warm compress/massage.

      Manuka honey is special honey made in New Zealand. It's basically the same stuff in Optimel, an eye drop from Australia that people have found helpful in MGD.

      Comment


      • #4
        Oil: great to know your oil is clear. Slow to secret, good to know why? I have never heard of it. Maybe your dr is more detail-minded which is great.
        All doctors just told me standard 10 min. which I found incorrect later - wasted about 3 months for NOTHING.
        To melt my thick oil, I actually need 15 min, 42.5 - 44C - I have done several studies on this.

        tea tree oil: if careful, it is ok.

        Monuka honey: interesting. grateful if you could kep us informed of the progress. Thanks!

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        • #5
          I think what the optometrist meant was that my oil was thicker than usual and prone to clogging. She said it should be expressing with ease. The manuka honey is stinging less (maybe I just used too much initially) and I am trying 100% cold-pressed avocado oil along my eyelid margin. So far, I am not having any problems with avocado oil; it is naturally slightly alkaline like the eye's pH, and there's minimal blurriness. I have tried castor oil and vit E in the past, but they were too viscous for me.

          Comment


          • #6
            Expression: seems you have a helpful dr. Should you express by yourself (by fingers?) or she will do it for you (by a special tool?)
            Did she show you how? This is important/effective but it is hard for us to monitor and it takes skills so best is performed by doctor.
            Too much is risky, too little is ineffective - this is my problem. I asked dr to show me but no luck and also no luck to find dr who perform expression.
            I do know if I over-do, my eyes feel drier.

            inflammation: Did your doctor perform InflammaDry test for you? I think it detects more accurate than the slit lamp.

            Avocoda oil: what is the purpose to put it along your eyelid margin? Did you consult dr on this? Since you have medical background, I am sure you know what you are doing. two of my doctors told me to keep everything 1cm distance from eyes.

            manuka honey: you use it in order to control bacterial inflammation? But your dr has ruled this out.

            I read somewhere, it is not good if we put too many ''different things'' into eyes, just something to share.










            Comment


            • #7
              Yes, I agree that doing too much can over-stress our eyes. I'm just trying to keep it simple with hot compress/massage, manuka honey and lacriserts during the work day. Avocado oil is just something I started today because it's what I have handy; it works no differently than mineral oil, castor oil, vit E, etc.

              If you search for "manuka honey" or "optimel" on this forum, you will find a lot of posts. Antibiotic agents like doxycycline and azasite are mainstream for MGD treatment, so I imagine manuka honey (naturally antibacterial) work in similar mechanism. Also, honey is anti-inflammatory. I don't want to take systemic antibiotics because it's bad for GI flora.

              As for expression, I watched some youtube videos of drs doing it, and I feel pretty comfortable doing them at home. There are tools on eBay you can buy for this. When I see the ophthalmologist next wk for lipiflow consultation, I will ask him his opinions on expression at home.

              Comment


              • #8
                Hi hosanna. Starting the new job working 40-60 hours a week and using your eyes a lot could be causing reduced or partial blinking, so the oils may not be releasing and possibly clogging up in the glands. And stress and lack of sleep has also caused our eyes to feel worse for several in this forum.

                If Lipiflow does not work for you, you might have old stubborn blockage, or even scar tissue inside the glands like I did. So Lipiflow did not work for me. I finally had to have probing to unblock my glands, then tried different diet changes until I found the right things to make my oils flow, so my glands would not keep getting blocked again. For me, drinking fresh lemon squeezed juice in strong green tea 2x daily was a major turnaround, something my system apparently needed to function correctly.

                For you, it may be something different, so I think you are on the right path looking into diet changes. However, you might need to unblock your glands first with Lipiflow. probing, IPL, etc. to see the effect of the diet changes.

                You might also want to consider getting meibography to see if you have any gland atrophy/loss, and if the doctor can see any scar tissue in these images. I never had this done because seems it has only recently become more available, but have read it can give a better idea of the state of your glands upfront, and help determine which treatment options would likely be more or less successful. In fact, here's an article MGD1701 recently shared on this:

                https://www.optometricmanagement.com...inical-dry-eye
                Last edited by Hokucat; 15-Sep-2017, 04:40.

                Comment


                • #9
                  Hi Hokucat, thank you for sharing your lipiflow experience with me. I will bring up probing and meibography at my consultation appt next week. How was probing? Did your eyelids bleed/become swollen? Was it painful? I am glad that your oil glands are working better now. How did you find out that your glands were producing again?

                  Maybe I will need some probing because my glands have been clogged for so long. I don't know if it's genetic or due to diet. I already have been drinking a lot of matcha green tea my whole life, but I will try adding lemon.

                  Comment


                  • #10
                    Hello hosanna. Yes, probing is much more invasive and uncomfortable than Lipiflow and IPL. I actually had the procedure five times over two and a half years. My eyelids never bled or became swollen, but one of the times my eyelids did hurt for the rest of that day to the point where my husband had to help me get around at the airport. Other than that, the other four times I was totally fine afterwards, even went out to lunch right after the procedure a few times.

                    The first four times I had probing, each time my eyes felt a little more moist, but within a week would go back to being dry like before. This is despite trying different diet changes right after each procedure. The fifth/last probe is when I started drinking the lemon/tea, and within a week my eyes felt less dry, and I did not have one debilitating dry eye day for an entire month, I stopped the lemon/tea for a week, and my eyes starting getting dry again, so am sure it is what did the trick for me. I've been drinking it every day for almost two years now, and my eyes have continued to feel better and have not needed another probe.

                    Per my eye doctors, I have some tear film now, the surface of my eyes are smooth vs. previously like sandpaper, and fluorescein staining shows I have one tiny dry spot on one eye vs. previously many dry spots on both eyes. But the main thing is my eyes just FEEL so much better now, and I am no longer homebound with my eyes constantly closed and in pain with virtually zero functionality. To me, that supersedes any clinical measurements by far. Now I can do all the things I couldn't do while homebound, like:
                    -Go outside for walks or shopping for several hours at a time.
                    -Tolerate wind, sun, air conditioning and fans well.
                    -Drive again comfortably.
                    -Use electronic devices, read, and watch TV again without pain.
                    -Spend the day at the theme park with my family.

                    I still have some remaining dryness from lost/atrophied glands, which scleral lenses help make up for. But during my worst years, I could not wear my sclerals at all, it was so uncomfortable. After I started getting better, I tried them again. Now I wear sclerals 12+ hours a day comfortably, I usually forget I am wearing them.

                    I too drank green tea by itself for many years, but it was not until I added the lemon that it made a difference. It was key for my situation, so am not saying it works for everyone else, but it's easy and natural to try, and apparently there is some scientific evidence on its benefits. Here's a few articles/studies I subsequently found on lemon/citrus increasing the impact of the antioxidants in green tea, and green tea improving ocular surface inflammation, TBUT, and meibum:

                    https://news.uns.purdue.edu/x/2007b/...rruzziTea.html

                    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5376801/
                    Last edited by Hokucat; 16-Sep-2017, 03:56.

                    Comment


                    • #11
                      Huh I will have to try the green tea and lemon combo then. Do you use a particular brand of green tea? Matcha powder has more antioxidants, so maybe I should start mixing pure matcha powder and hot water to get a more potent 'green tea.' Do you have aqueous deficiency, too, or just MGD? The optometrist said that what little tears I do have are evaporating instantaneously due to lack of the lipid layer.

                      Comment


                      • #12
                        Probing: I asked one dr if probing, IPL etc would help me. Yes, was the answer. But 3 doctors said I dont need it since no scar tissue been found.
                        Seems scar tissue is related to inflammation which I dont have for the last 1.5 years.

                        Most doctors are not solution-driven nor knowledgable, best is you find solutions by yourself and ask their opinions - that might be more effective.
                        In the meantime, best you rule out possible causes in order to identify real causes.

                        Osmolarity test & InflammaDry test: Have you dont these useful tests? Lots of benefits - monitor status, tear quality etc.
                        These are pretty standards now in USA.




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                        • #13
                          Those tests have not been offered to me, but I will ask the ophthalmologist on Monday. The optometrist did not think my dry eyes were due to inflammation; this also explains why Restasis didn't work for me. I really think I just have aqueous deficiency (due to severed nerves) on top of MGD. I really hope lipiflow helps.

                          I just started wearing my scleral lenses again today. I don't like wearing them, but the alternative is being in 10/10 pain at work.

                          In the meantime, my regimen will be manuka honey on eyelids, fish oil (1g/daily), flaxseed oil (1 tbsp/daily), and adding lemon to the copious amounts of green tea I already drink everyday. The hot vapors from my mug are soothing for a few minutes at least...

                          Comment


                          • #14
                            Hosanna, I use the Costco Kirkland Green Tea, it's a combination of matcha and sencha. I put the bag in warm water and hit it against the side of the cup with a spoon at least 100 times, so it gets a dark green and really strong, then squeeze in the juice of 1/6 slice of a medium/large Meyer lemon. I often add in crushed ginger and a small handful of goji berries, and then drink it right away (2x daily), so it does not lose potency from being exposed to air too long. I've read any green tea that is more on the brown/green side has been over processed and the antioxidants compromised, so would stay away from those teas.

                            Yes, I also had aqueous deficiency too. No oil and no tears was debilitating!

                            Comment


                            • #15
                              Just to update: I will be getting lipiflow on Wednesday. The ophthalmologist told me my glands are blocked and aren't secreting anything when he stabbed my eye with Q tips. I dont think they are the correct tool to apply enough pressure. When I express at home using my expressor tool, I do see clear oil. It's slow and thick, but it's there. I also started a short course of azithromycin today. Studies have shown that a 5 day Z-pack was superior to 1 month of doxy with fewer side effects. I prescribed myself 500 mg daily azithro for today, tomorrow and wed in prep for lipiflow. I am hoping that azithro will augment lipiflow by thinning the oil and reducing inflammation.

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