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Thread: Lasik induced dry eyes

  1. #1
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    Lasik induced dry eyes

    Hi everybody
    My name is Cristina I'm 32 years old and since lasik 5 months ago I have severe dry eyes (I use to score the same values every time 4 mm left eye and 9 mm right eye without anesthesia).I also seem to have MGD (I detected myself cause the doctors tell me I only have blepharitis...

    Here in Romania we don't have dry eyes specialists and they continued to give me antibiotics and anti inflammation drops for treating the conjunctivitis and blepharitis that I developed post op. I felt much better when I took Tobradex so I guess I have an inflammatory issue.
    I'd like to ask some questions to the people here on board who had also this horrible procedure.
    1) my left eye is much worse than my right one even if the schirmer difference is not that big; during the procedure I actually felt pain in my left eye when they applied the suction ring (they told me my left eye was smaller so they had to apply greater pressure on that eye) I guess that they damaged more goblet cells on my left eye which triggered more inflammation which might explain the lower schirmer score; could this be possible? has any of you had a similar experience?
    my right eye is dry and I sometimes feel the burning but the left ... I almost feel it like the eyeball is separate from my eye socket and when I apply gel I feel it like a glue...

    2) at 3 month mark a doctor told me I had a corneal scar on the left eye and he sent me for a virus testing, it came back positive for herpes simplex 1; the scar has not been detected by 2 other doctors and I didn't have any symptoms of herpes infection (I looked over the internet); has any of you had a herpes infection and now is on restasis? (I'm asking because i heard that allergan didn't make tests on people with herpes so I'm a little afraid to try this drug)

    3) I got some autologous serum from my blood and the lab put it in plastic items; is this ok or it should be freezed only in glass bottles?

    4) is it still possible to have my tear production get higher without steroids and restasis?

    I also had all the possible blood tests for sjogren and it came back negative.

    Sorry for the long post and many questions but where I live I haven't met anybody with such severe dry eyes post lasik.

    Thank you for helping me.
    Have all of you a nice day.
    Cristina

  2. #2
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    Hi Cristina,

    I'm sorry to hear that you are going through post lasik dry eye. It is good that you have found DEZ. There are a lot of people here with lots of experience.

    I am 9 months post lasik and have learned a great deal by following many of the posts here on DEZ. I shall try to answer some of your questions.

    1) I don't know that the suction ring actually damages the goblet cells. The ring can cause an increase in floaters. Usually people experience greater dryness in the eye that had the greatest ablation. I too have found that some gels and drops (celluvisc) feel like glue on my eye. I just avoid those drops.

    2)It is a shame that the first two doctors missed the scar and the infection. I am guessing that Allergan did not run trials on people with the virus, just because they were trying to eliminate some of the variables that could contribute to dry eye. I am assuming that the virus is now in a dormant stage. I would be asking my doctor and pharmacist if Restasis could trigger another outbreak.

    3)The autogolous serum is routinely placed in plastic bottles, much the same way as artificial tears.

    4) I have never used restasis and only used steroids very briefly. I do think my tear production has gone up. Tear production is a complex system, influenced by many hormones. Cortisol, the stress hormone, probably has the greatest effect on tear production. It is a shame that there is not more scientific research being done in this area. You can probably tell from your own experience that when you are anxious, your mouth feels drier. It is very likely that your eyes will be drier as well. So . . . relax! Purposefully do things to make yourself feel at ease! Notice how your eyes feel when you are relaxed. I personally find that deep belly breathing sessions disrupt the visious cycle of fear that dry eye can perpetuate.

    Hopeflu2

  3. #3
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    Hi Hopefull2

    Thank you so much for your mail. All the good information about my condition I have it from here. It's very hard to accept that one day you were normal and next day nearly incapacitated. I was a contact lens wearer till 2 years ago and haven't had any issue with dryness. Now after lasik I did all the blood tests for autoimmune and hormonal and all came back good except some androgen that I have in excess (even if I heard that a lack of androgen could cause dry eyes and not an excess of it).

    Regarding the dryness I had the same ablation in both eyes (100 for the flap and 100 the ablation) so I really can't explain the difference between the eyes but from the suction ring pressure. What was your ablation? Did you have microkeratome or bladeless? Maybe my ablation was too deep...

    Today I went to another OD they did another schirmer without anesthesia and the right eye was almost normal 14 mm they put me a temporary punctal plug in my left eye (without anesthesia it took like 30 seconds and I didn't feel any pain). They also confirmed me that I have a mild case of MGD.
    The warm compresses feel good but after that my eyes feel dryer than before. Have you experienced that? Did they gave you the serum directly in bottles with eye droppers?

    You are so true about the stress thing.....after I realized the bad outcome post lasik I was desperate could not sleep I cried a lot; the surgeon told me I might have sjogren, I went home googled and began to develop all the other symptoms first dry mouth all night then loss of breath then pain in hands and legs ; it's amazing how much we can be influenced by our state of mind. Now that I'm emotionally better I don't have any symptom at all except the dry eyes of course...

    I began to put the serum but it feels a little like glue not so lubricating; I remember you said something like that too in some previous post. Anyway hope will help.

    I hope that in time my tear production will go up by itself. I'm a little afraid that in time if the nerves will not regenerate soon enough the lacrimal gland will become atrophied. Have you heard about that? I'm considering taking pilocarpine orally even if I'm afraid of the risks.

    All the best
    Cristina

  4. #4
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    My serum is in little plastic eye dropper bottles.

    I find the serum comforting in the first five minutes and then my eye starts to feel a little dry.

    I don't believe the gland can atrophy until after several years, and even then it would need to be due to autoimmune issues. The nerves are regenerating. . . it just takes time. I have read that it can take anywhere up to a year or even two for the nerves to regenerate.

    I'm not sure why you would take pilocarpine?

    Do some research here and see all the good nutritional supplements people are taking. The web site 'natural eye care' lists some good products as well.

    You have to believe that your body heals itself from ailments all the time. It will heal your eyes as well. When you panic about your eyes, the healing slows down. I know how hard it is to trust the healing process.

    I had the suction ring placed twice on the left eye. The first time, the doc did not like the position, so they did it again. It was not very comfortable. Now I am having greater issues with this eye.

  5. #5
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    Hi, pilocarpine acts like a neurotrasmitter similar to the natural acetylcholine but obviously has side effects.
    I guess the lacrimal gland will not atrophy in short time but maybe will not be able to function as good as before.
    I already take a lot of supplements but for now I'm not seeing much difference in my symptoms.
    WIsh you a total recovery!
    Cristina

  6. #6
    Christina -

    You are not alone. I have severe dry eye since having Lasik. I have tried many different things but not getting much relief. There is a new procedure called IPL which I've heard some people get relief from. My insurance will not cover it but am hoping they will accept a payment plan. Do want to research it more though. My eyes are so dry that I can't drink regular coffee or alcohol as it makes my eyes worse (diuretics). I have trouble going to malls, grocery stores, concerts, etc. Has definitely affected my quality of life. Just keep trying different things and keep your hopes up. Sooner or later, someone will come up with something that will help us all. Just wanted to encourage you and tell you that you're not alone. Good luck!

  7. #7
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    HI
    Thank you for your beautiful words!
    i really need encouragement and I try to maintain hope but reading that you and many many others struggle with this condition for years without much relief is very discouraging.
    I' only 32 have a beautiful daughter 1 years old and feel like my good life that I lived for 32 years is totally ruined.
    Like you I worked only in front of a PC at least 10 hours a day, now I come back after maternity and lasik part time and even 4 hours are too much for my eyes. All the long hours I spent in the past at work are now washed out. I'm fortunate that they accept me part time but I have to say bye bye to my career.
    I don't understand why they are continuing destroying people's eyes. I don't understand at least why they don't practice only surface ablation like lasek/prk as they are safer? What's the benefit of the patient with lasik? None....there are studies that highlight better visual outcome after surface ablation...what's the point? Why having to let a permanent wound in the eye that never heals and to which the body reacts like to a foreign tissue? Did you know the inventor of lasik is the inventor of restasis? Isn't it odd? Ciclosporine the active ingredient is also used in transplants....

    I do have to believe that it will be punishment for who is practising/allowing this to happen.
    All we lasik sufferers should find a way to be more active and have them stop this horrible procedure.
    I haven't met on person anybody yet with similar problems but I'm sure I'm not the only one here in Romania.
    Hope someday someone with no financial interest will find a cure and we will be able to have access to it.
    All the best
    Cristina

  8. #8
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    Hi Cristi,
    I too echo your sentiments and have since my lasik surgery tried to bring some light to the lasik company who did my surgery, but truth is, they don't want to hear it. It is a huge money making industry and sadly patients who have a less then desireable outcome are the least of their concerns. They would rather sweep us under a rug then acknowledge what we have (and continue to) go through with dry eyes, not to mention all the other side effects. I feel for others who will have this surgery and come out like us as there seems to be no warning or honest disclosure about the real risks.
    This may sound a tad depressing but it has been my experience with these companies. I say this as I'm off today for my follow up apt with Dr. Caffrey in Toronto to see if there's been any improvement with my dry eyes.
    All the best Cristi and trust there is a strong support group here at least,
    fiddle

  9. #9
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    Hi
    Thank you for your kind reply.
    I try so much to understand what is wrong with me as I developed so severe dry eyes after lasik.
    I'm sure the cause is not only related to the nerve damage. I think I might have some autoimmune issues even if all the tests are negative and I haven't had any problem with dryness previous to this eye procedure. I consider this because I have now very low tear production 4 mm in one eye and 9 mm or 14 mm in the other (without anesthesia). The results are always the same. However the bad eye felt very painful during the procedure so maybe the very low tear production might be connected to the trauma. I really don't get why there is so much difference between the eyes.
    I remember you said you were tested for sjogren and it was positive. Have you had a lip biopsy or just blood work? Did your doctor made a schirmer test?
    Some eye doctors think I might have sjogren but the reumatologists do not agree.
    Also it is true that I have chronic blepharitis (I had a chalazion before lasik but at that time I didn't consider it because I didn't felt any dryness and who made the screening before procedure didn't tell me anything about it). I know now that blepharitis should be a contraindication for refractive surgery.
    Also I was 6 months after birth and still occasionally breastfeeding at that time so I guess the hormonal issues played an important role in my poor outcome. Of course I didn't knew it because the surgeon didn't tell me breastfeeding was also a contraindication. I know it now
    Thank you for your time and kindness.
    Cristina

  10. #10
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    Hi Cristina,
    I do have sjogrens yes and my bloodwork alone was enough so no I did not have a lip biopsy. Dry eye patients tend to find a combination of remedies that help us cope. Dr. Caffrey told me that yesterday, that it has been her experience that her patients are very good at fidning what works for them. My first schirmers test was pitiful, 1 in the left eye and less then 1 in the right. It has improved to 2.5 in the left now and 2 in the right.
    I use a combo of Omega 3's and astaxanthin which has helped the most for me I have found. Have you thought about seeing a naturalpath? They are great and you mentioned you were breat feeding and only 6 months post-natal so I wouldn't be surprised if your hormones are playing a part in this too.
    The road now for me is whatever works on whatever day, sleep is a biggie too, once I got that under control things felt better.
    Hope some of this was helpful for you Cristina,
    fiddle

  11. #11
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    Hi
    Your schirmer results were with or without anesthesia?
    I tried already many supplements like fish oil flax seed even triphala ghrita but doesn't seem to bring any relief. I also do acupuncture with no results either.
    I'm planning to put lower punctal plugs. Have you tried these? Where they helpful to you?
    I also find sleep is very important I sleep a lot at least 10 hours at night.
    Thanks again.

  12. #12
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    My schirmer tests were both with and without anesthesia, one with another without, but the last was with it.
    I did try lower punctal plugs yes (both temp and perm) but they both fell out. I didn't like the feel of them, but you might have a different result. I went into it trying almost anything for awhile there.
    Sounds like you've already tried a few ideas, don't give up and time works wonders too. I saw one corneal sp last year and he said to give the eyes 2 years after lasik. I've also read on this site about the nerves taking up to 5 years to regenerate as well.
    You're right about sleep being so important too, and for me, my anxiety levels played a huge part in how I felt too I believe. Once all this came under control I felt a lot better. That's not to say my dry eyes are gone, after a 4 hour drive today they burn like no tomorrow (a cold conpress felt great when I got home), but I cope a lot better now. I have accepted my habits of drops every hour and gel throughout the night. It has become second nature now to me much like I sip water all the time and apply my chapstick for my dry mouth.
    Keep looking for what works for you and as this year post lasik goes on for you, your eyes will feel different no doubt.
    fiddle
    P.S. please forgive any typos, the eyes can only do what the eyes can do

  13. #13
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    Hi
    Thank you for encouraging me. Indeed yesterday I went to the doctor and it seems like my tear production is better almost normal. I think it was due to the reflex tears. However my eyes feel the same. The doctors here don't want to perform shirmers with anesthesia they say they are not reliable. I hope for improvement over the next months. Maybe I will be among the lucky ones. Thank you so much for sharing your experience and advices.
    Cristina

  14. #14
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    Hi all lasik sufferers
    Please help me......it seems like I have a lot of reflex tears the values increased significantly over the period of 6 months after lasik from 4 and 9 mm to 22 and 24 mm.
    When I began to hope things will get better they did a schirmer test with anesthesia (they put the anesthetic 3 times over a period of 15 minutes so I was anesthetized like for an ocular procedure) and the results were 0 in one eye (the good one???) and 2 in the other one.
    Based on your experiences and tests, do you think the only explanation would be sjogren? All tests came back negative....
    Thank you all so much for support.

  15. #15
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    Hi Cristi,
    I can't say for sure for you, but those are very low scores. Have you seen your family doc for a referral to a rheumy? A rheumy would be able to figure out if it's sjogrens or not. I have a lot of other symptoms besides my dry eyes that I've also had for years but have gotten progessively worse over time (dry mouth, dry sinus, joint pain, extreme fatigue, raynards syndrome ect). These combined with the blood work gave my a positive dx for sjogrens. If you're concerned about it being sjogrens I'd approach your family doc about it and go from there. Hope that helps some.
    fiddle

  16. #16
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    Thank you Fiddle
    The fact is according to the blood results the rheumy doctors say I surely don't have sjogrens. All my tests are ok.
    So I am wondering is anybody here on the forum with a case similar to mine and don't have sjogrens? Had lasik 6 months ago, previous I never had any problem with the dry eyes or other type of dryness. I had blefaritis with no symptoms. According to the tests my reflex tears is turning to normal post lasik but my basal tears seems non existing. I do not have corneal and conjunctiva staining anymore although in the first months after lasik I had some staining. My symptoms seems to be getting better (I manage well with my ziena oasis and thera tears 4 times a day and one drop of gel before I go to bed).
    I imagine that according to the schirmer result I would have some staining and a lot of pain.
    I really don't understand what is going on.
    I would appreciate your answers.
    Cristina

  17. #17
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    Hi Cristi,

    Your description of what you are experiencing with reflex tears and basal tears is similar to mine. I have never had an anethetized schrimer's test. I do feel like my reflex tears are improving. I did read somewhere, that there is no such thing as basal tears, that all tears are due to blinking and therefore due to reflex. Also, keep in mind that the anesthetic drops are VERY drying. They could potentially dry cause any amount of tears that are formed to dry up.

    I too no longer have staining on the conjungtiva, although I did in the early months. I am ten months post lasik now. I think the dryness problem now is due to poor mucin layers. The goblet cells that make the mucin get damaged with dryness (inflammation). The theory is to manage the inflammation and treat the dry eyes with drops (and ointments if necessary). I use gel before bed and wake up at least once to reapply drops.

    I think the recovery process can just be really loong. I read on the 'laser my eye' website that someone had dry eye for two years following PRK, and then it went away. So there is lots of hope that things will get better.

    Do you notice that you no longer get crust in the inside corners of your eyes in the morning?

  18. #18
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    Thank you Hopeful2
    I was fitted with 2 permanent plugs in the bottom punctum and it surely feels better. I do not need any artificial tears but I still to wear the moisture chambers when outside or at work. I guess I definitely have aqua deficiency but it is clear that I produce some tears otherwise I would be much worse.
    If the theory with no basal tears is true I wonder how come the normal people do obtain scores of 10 mm at the schirmer with anesthetic? Wouldn't their tears dry up as well?
    Ever since my lasik nightmare I have salt white deposits at the top of my eyelashes. Do you experience that too? Do you know what these are? Are a result of the dryness resulting for the increased osmolarity or it might be a result of the MGD (I have posterior bleph)?
    As for the morning crust I do have a lot but I'm sure it is all due to the gel residuals.
    Cristina

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