New optometrist visit and a new treatment plan
I'm just back from an appointment at my local optometrist.
Background is that I've was seen by a very disinterested and dismissive ophthalmologist a couple of weeks ago, and have been referred by my GP for a second opinion from someone specialising in ocular surface disorders (this will take a couple of months, probably).
In the meantime I decided to go for an examination at my optometrist as they specialise in treating dry eye disorders, and have a Dip Tp qualification which means they can prescribe medicines (at least that's how I understand it!)
Anyway, surprisingly, they have said I don't seem to have blepharitis - so all my lid hygiene measures over the past three months must have been doing some good after all. The papillary reaction which was seen during my last exam on June 19th seems to be greatly reduced now, as well, just a small area in my left eye. However, he said my right eye is not producing much in the way of oil - which is probably why it's more symptomatic.
What I do still have, though, is inflammation. Quite a bit of it. He took a very thorough history and says that systemic causes need to be looked into, although his first line of investigation is that all the preservatives, from contact lenses, drops etc have caused or exacerbated this inflammation.
So: what to do about the inflammation. As I've already shown a reaction to the preservatives in FML drops, he has (privately) prescribed Dexamethasone minims, to be used four times a day for 20 days, with review in 2 weeks time. Also to use Vismed 4x day and continue with lid hygiene and cold compresses (as warm compresses seem to increase inflammation for me). I was given all kinds of tests - eye pressure, visual field test, corneal thickness, retinal imaging, macular imaging... turns out that I have thick corneas which is why my eye pressures seem to be high - they're reading 20, but adjusting for corneal thickness means they are actually about 15 or 16.
All this was much more detailed and thorough than the consultation I had at the hospital by the ophthalmologist, and I do feel like I'm going to be well looked after with these guys. However I'm still very concerned about the steroid use - I am very scared of doing anything which could cause even more problems, short or long term.
There is still the question of what's causing the inflammation, of course. I will certainly ask about tapering off the steroid use as soon as possible, assuming they have no other adverse affects in the meantime.
Bit confused why my right eye isn't producing much oil if I don't have blepharitis...? Isn't this effectively the same as MGD?
Writing this while just back, bit flustered - will probably think of loads more questions and concerns later this afternoon. Very sore, dry eyes after all the poking, prodding and flash photography, so off for a cup of tea and a cold compress
I think MGD is the name they give for a lot of different problems related to the lipid layer that they don't know the cause or what to do about it.
I am trying to understand the distinction between the different labels given to more or less the same thing.
I'm guessing posterior blepharitis is another name for meibomian gland dysfunction? I think the optometrist said he didn't see blepharitis as there was no sign of bacterial infection and he described my eyes as 'very clean'. However it seems the meibomian glands on my right eye aren't functioning correctly, for whatever reason, so this I suppose could be considered MGD?
Still confused - but started on the dexamethasone drops this morning. I am very anxious about the steroid use but at least it's being closely monitored.
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