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Thread: menthol sensation (more debilitating than pain)

  1. #1
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    menthol sensation (more debilitating than pain)

    Wondering if anyone has the sensation that has most adversely affected me. . .It is what I've heard some foreign doctors call "menthol sensation," like a cold, mint wind is blowing right in to your eyes, even if you're just standing still, indoors, in a perfectly calm-aired room.

    I also have burning pain, which has been well-controlled by Restasis. . .

    I control the menthol sensation with my moisture chamber glasses. . .For a long while, I had a hard time convincing my docs that the menthol sensation was debilitating me. . .and so I started to call it "pain." It is actually, for me, much worse than pain. . .It makes me need to close my eyes. . .which means turning the whole world off, since I am not blind. . I so wish this phenomenon were better documented. . .

    Perhaps I should call it air-sensitivity. . .does that sound right?

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    From your description, I don't think I experience this type of pain. Your mention of it was the first I had heard of it.

    The kind I have is the "foreign body" sensation--and usually my eyes get really red with it--and little pieces of solid mucous form in my eyes, too. Maddening. Gel, closing my eyes, and Time--usually overnight--and it goes away. I used to think the solid globs were the result of a bacterial infection, but it isn't that.

    C66

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    I've had this sensation! It is awful and extremely debilitating. I could not keep my eyes open no matter how hard I tried. I remember laying in my bed with my eyes shut, wondering how I was going to get through the next minute, hour, day. I didn't think anyone else had this. Plugs were the only thing that resolved it. I really don't get this type of pain anymore -- now it's more of a tight, irritated, burning type of pain.

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    thank you for menthol echo

    Thank you, Julie, for echoing the experience of menthol sensation. . I am thrilled that plugs have stopped that, for you. . .I've had plugs for nearly 8 years, but the menthol sensation remains my primary debility. . .probably because my tears are essentially devoid of lipid, and the more that flow down, the faster they seem to evaporate. . .

    Anyone else dealing with menthol sensation?

    I am in a quest for DHEA drops now, because I sense that they alone can directly affect (positively) meibomian function in endstage cases that fail to improve with lid hygiene and long courses of doxycycline (I gave doxy about 6 years before giving up. . . )
    Last edited by Rojzen; 09-Feb-2007 at 17:53. Reason: typos

  5. #5
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    I might describe my eye discomfort as a menthol sensation. It's sort of like licking your finger and holding it to the wind. You feel the cool feeling of air. If I dipped my finger in oil, I wouldn't feel the air at all. This is why I wear goggles outside and in my car. I used to wear them indoors as well until I got my comfort a bit more in control.
    Never play leapfrog with a unicorn.

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    I second what Diana said.

    If you pour isopropyl alcohol over the back of your hand, it evaporates very, very quickly. What you feel is a "severe" cooling sensation that surely could be described as a "menthol moment."

    That sure sounds like severe evaporative dry eye (very short tear breakup time) to me ... and mine's usually less than two seconds.

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    your images are perfect (menthol sensation)

    Neil and Dianat! You've perfectly captured the menthol sensation. . .In fact, I used to tell people that what I feel is similar to the sensation of sticking out my tongue, and letting it dry in open air. . just like Dianat's description of the wet finger in the wind. . and YES!! Alcohol would produce this, just as an oil coating would warm the surface, block evaporation, and end the sensation. . .Thank you, friends, for identifying!!! And yes, Neil. . .This means, at least for me, VERY fast evaporation. . .My evap. time (TBUT) is still 0 seconds. . .Just last week, my eye doc said the evap. was instantaneous. . .I have gotten as high as 5 seconds, from time to time. . .but mostly, I essentially have no tear film at all. . .Seems miraculous that I get so much relief from the moisture chambers. . .I'm eagerly awaiting that book that is coming out in March, about bringing meibomians back to life. . .I'm not optimistic, for me, but it's good that some doc is thinking seriously about this. . .and as Rebecca says, for MGD, our mission is more so reactivation than it is lipid replacement. . .Thanks, guys. . .

  8. #8
    Hello Rojzen,

    The book about bringing meibomians back to life--do you know who the author is? Is it Dr. Latkany?

    Thanks!

    Judy

  9. #9
    I'm definitely with you on the menthol feeling -- I seem to alternate back and forth between the sandy-gritty feeling when my eye-lids are inflamed and the "menthol evaporation" sensation you're describing when they're not. Nasty, nasty sensation.

    And what's this book you're talking about? God knows I'd love my MGD to go away...

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    reviving meibmomians

    I have read only Dr. Latkany's book, but I sense that all the new publications on dry eye prescribe regimens designed to reactivate/normalize the meibomians. . .Any program involving lid scrubs and warm packs is targeted mostly at getting meibum to flow more freely...

    That said, I believe that all of the regimes advocated, along these lines, completely disregard that some of us have endstage meibomian disease, with gland dropout. . .It can, I fear, be a disservice for practitioners to harangue their endstage patients about proper "lid hygiene" long after this approach will have ceased to be useful. . .I did compresses, dry heat, and lid scrubs, and even a retinoic acid chemical peel on my lid margins for 2 years, with absolutely no response. . .I got better when I simply stopped. . .

    And so while MANY of us can bring our meibomians back to better function, for those of us cannot do so via lid hygiene, we need to look elsewhere. . .I believe the androgens will be a breakthrough, in these cases, though I suspect they will have to be coupled with a peel, of sorts, that opens any gland orifices that are sealed by metaplasia. . .

    Bottom lin, however: It is ENTIRELY possible to function well even if the meibomians don't come back. . .I have been doing so for 8 years, now, thanks to moisture chamber glasses and a series of topical meds. . .This approach eliminates my menthol sensation for about 75% of the time, which is, for me, the gift of life.

  11. #11
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    Quote Originally Posted by Rojzen
    I have read only Dr. Latkany's book, but I sense that all the new publications on dry eye prescribe regimens designed to reactivate/normalize the meibomians. . .Any program involving lid scrubs and warm packs is targeted mostly at getting meibum to flow more freely...
    To tell the truth this is a point in which I was disappointed in "Reversing Dry Eye" which does not do much at all to bring attention to the MGs. I think this is because the treatment plan is based largely on the famous Delphi panel's 4-level pat "flowchart" type dry eye approach which I frankly find mystifying - for something from such an elite crew I was amazed it does not really make any distinction between aqueous and meibomian deficiency. I was also kind of turned off by the way the panel's approach lumps treatments, like putting moisture chambers in the end-stage class with surgery (!!!).

    That said, I believe that all of the regimes advocated, along these lines, completely disregard that some of us have endstage meibomian disease, with gland dropout. . .It can, I fear, be a disservice for practitioners to harangue their endstage patients about proper "lid hygiene" long after this approach will have ceased to be useful.
    Quite. The fundamental problem IMHO is prescribing treatments without getting hands-on with the glands to find out whether & how well they're working. I know I harp on this a lot but once again this is one of the biggest problems out there - lack of knowledge/training in doing a decent lid margin exam. (Those who were at our mini-conference last year may remember Sandra Brown's tutorial on what should be done during a lid margin exam....) Among all the dry eye folks I talk to during the day I find it frustrating/amusing how typically they were never told a thing about MGs and don't seem to have ever had them examined... but have been prescribed treatment as though they have MGD. Flip side of that coin. They probably do (have MGD), of course, speaking statistically, but they only get the treatment by good luck since their doc is basically just going through a mindless checklist of "stuff to do" rather than prescribing for a diagnosed condition.

    I think that probably quite a small percentage here have a large number of completely atrophied MGs and in those cases moisture chambers are absolutely vital as far as I can tell.
    Rebecca Petris
    The Dry Eye Zone

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    Yes Yes Yes! I have been feeling this for years...currently being worse than before. When I was reading the forum, I didn't understand what people meant by "pain" since I didn't really feel pain, persay, at least not in the conventional sense. I've tried to explain this sensation to several doctors and they just gave me a confused, you're crazy look.

    I walk down the hallway at work w/ my head down and eyes practically closed because the menthol sensation is just too horrible. I am glad to have found this thread and people that understand!! I hope you all find relief from this horrible sensation.

    I plan on visiting Dr. Latkany later this year if I don't find any more relief for my eyes. I'll be sure to ask him about this!

  13. #13
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    I get this too, and it's totally different from the burning sensation. I also get the gritting sensation. The menthol one is particularly unpleasant as you feel like there's really nothing you can do to explain it or help it.

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    a voice is emerging on menthol sensation; anyone without low TBUT?

    What a great swell of recognition these posts form for that truly exasperating sensation that feels like menthol, or cold air, blowing directly on the eyes. . .

    Interestingly, lots of us who have this problem also suffer from intermittent burning pain and grittiness. . .Thus far, though, all the symptom lists on artificial tear products seem entirely to neglect that windy, menthol disturbance, all the while those of us who live with it know that it is at least, if not more, problematic than anything else, because it essentially forces one to close or squint eyes shut, just in order to cope. . .

    I've posted a q. about the physiology of this sensation for Dr. Holly, because I suspect he will be the first scientist to be able to explain and otherwise address the problem. . .

    I also want to say, for those here who may not have tried protective eyewear INDOORS, on a 24/7 basis, it may be possible virtually to eliminate the menthol feeling, or, at least to reduce it to a really manageable level, through such eyewear use. . .I've been getting by that way for over 8 years now. . .

    Nonetheless, I actually believe that a treatment will be developed that will help stop the menthol sensation . .or that there is something out there that may already have the potential to do so. . .

    Does anyone here have menthol sensation, btw, who does not also have MGD and a very low tear break-up time? That would interest me greatly. . .

    Finally, I have to credit the term "menthol sensation" to a lovely young Egyptian post-doctoral fellow I met at Dr. Tseng's office in Miami, about 7 years ago. . .Like so many of the doctors who end up in our field, this one himself had DES, and, particularly, suffered from menthol sensation. . .
    Last edited by Rojzen; 24-Jan-2008 at 10:01. Reason: typo

  15. #15
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    I never had "menthol" until I got four punctum plugs. I didn't have so many excess tears that they overflowed, but just kept my lids uncomfortably moist. At the time I thought of it as excess evaporation. After 5 weeks, I had the uppers removed, and the sensation went away completely.

    My "logic" says that the watery tear layer predominated over the oily layer during this time, but that my meibomian glands normally produce enough oils to keep my minimal tear quantity balanced.

    It makes total sense that protective eyewear can really help with this symptom, because as long as there is air movement or a difference in humidity between the eye surface and the environment, the tears will continue to evaporate and be produced (and evaporate again).

    Just curious Rojzen, do your tear glands produce a "normal" amount of tears---and it's just that your meibomian glands are non-functional?

    Calli

  16. #16
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    No matter the science behind it, I tend to believe I would not experience the menthol sensation if I had the proper oils in my tears and and so long as those tears were sticking to my eyes.

    Curiously enough, and I think this is a huge clue, my eyes are less weepy when they are at their best. Since I'm cauterized in all four punctae, I need to blot very frequently. On a really bad, burning day, I might plot twice as often as on a good day. This could be due to reflux tearing, or tears not sticking to the surface of my eye...who knows. On better days, blotting is still necessary, but if far less frequent. The menthol sensation somewhat less of an issue on these days as well.
    Never play leapfrog with a unicorn.

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    a shared eureka!

    Calli66 and dianat, your reasoning about the RATIO of liquid to oil, and its relationship to whether we have menthol sensation and comfort, overall, is EXACTLY what I've hypothesized for years. . .I've always told my eye docs that my BEST days were some of my driest. . .and that the windy/menthol sensation was worst when tears lingered on the lid margins or dripped from the eyes. . .

    A small handful of artificial tear products don't immediately worsen my menthol sensation, even though they throw the lipid/water balance off. . .These are Systane, the Dr. Holly drops, and some of the older PVA drops. . .Anything with mineral oil, lanolin, or petrolatum SEVERELY worsens the menthol sensation the moment the oily coat wears off. . .

    To answer, my lacrimal production ranges from a little below normal to low (based on flourescein clearance testing, rather than the plain old Schirmers), and I've always felt that the severity of my symptoms cannot possibly be accounted for by such a relatively small lacrimal abnormality. . .In contrast, my meibomians are horribly abnormal. . .Most don't even exist anymore (:^). . .or so I'm told. . .

    I suspect there won't be many or any on this thread who report menthol sensation with normal meibomian function. . .We shall see. . .

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    I think you may be describing the sensation I sometimes have. In my early, post surgery days, I described my sensation to feel as if I was "sticking my head in a freezer with my eyes wide open". My surgeon also looked at me like I was nuts. Sometimes I feel a cold air sensation on my eyes and it is maddening. I especially feel it in grocery stores and malls. Not really "pain" but it is uncomfortable to say the least. I have dry eyes from lasik, obviously. I don't know about the oils and such in my tears, I'm not that educated on all these topics yet. I do know a corneal specialist I saw said there are no "dry spots" on my eyes. I thought that meant the oils are sufficient. But my tear testing was a 2 in my left eye and a 3 in the right. This was many months ago before Restasis or my plugs so I assume my numbers are a bit higher now. But the "menthol" description seems to nail what I sometimes feel.
    As far as wearing the panoptx goes, they are the #1 thing that relieves all my symptoms. I love them. I can't get over feeling goofy in stores though wearing them. I hate people staring at me. I guess I can be vain and in pain or just get over it.

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    freezer sensation; tongue-in-the-air sensation; sclerals?

    Yes, yes, yes. . .Eyes wide open in a freezer describes EXACTLY the maddening so-called menthol sensation. . .Some time ago, one of us described the experience as parallel to the way one's tongue would feel, if one left it hanging out of the mouth, exposed and drying. . .

    I think we are raising consciousness about this problem by sharing our subjective experiences with it, and then likening these to experiences that people without dry eye can relate to. . .In turn, maybe our eye doctors and researchers will begin to take an interest in this, using it diagnostically, and also attempting to deal with it. . .

    In meantime, I am trying to figure out whether rigid gas permeables of any size might help with menthol sensation. . .

    Does anyone have any experience trying to stop the menthol by wearing RGPs?

    Pending a truer solution, what on Earth would we menthol types do without Panoptx and other moisture chambers???

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    In meantime, I am trying to figure out whether rigid gas permeables of any size might help with menthol sensation. . .

    Does anyone have any experience trying to stop the menthol by wearing RGPs?
    Most certainly. Well, I didn't wear lenses specifically for that reason but they sure were effective for it. I should think anything from a corneal-scleral on up would give quite a bit of protection. I wore such lenses for 2+ years before switching to full sclerals.

    Gas permeable lenses are made on quite a wide spectrum of sizes for a variety of purposes. You've got the standard small ones that people with nice healthy properly-shaped corneas use. Then you've got larger and larger ones that are used particularly on people with misshapen corneas (keratoconus, post lasik, post rk, etc) till you get to the corneal-scleral lenses which partially vault the cornea. Then you get out to 15mm and beyond which are typically called mini-sclerals, and finally you get out to say 18mm and beyond which are typically called sclerals.

    Broadly speaking (no pun intended) the larger the lens, the more comfortable it is, if properly fitted.

    I've worn both 14.5mm corneal-scleral lenses and 18.5mm Boston sclerals. I get the best protection from the 18.5s because they're covering the most surface area and do not touch the cornea at all. But I'm thinking it's the in-between ones, like what DrG is working a lot with these days on a highly customized basis, that would probably be most suitable for the purpose you're talking about.

    Caveat: Outdoors in the wind, I don't believe ANYTHING but a Panoptx type product can do the job.
    Rebecca Petris
    The Dry Eye Zone

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    When I was reading this forum a lot over the summer, after having been diagnosed with DE, I saw this thread, and Rojzen's words "menthol sensation" kept entering my mind, but I did not know how to respond. It is so hard to describe the feeling, but I cannot think of a better way than Rojzen's.

    In fact, for me, for years before I even knew I had a problem, I just responded without knowing what I was responding to. I closed my eyes. That's the only thing that really helps that feeling for me, and it "warms" my eyes. Sealing them off away from the air is exactly what closing them does. It's usually later at night when I get that feeling, and I know it is a "bad eye day" whenever it comes earlier.

    Thanks Rojzen, you are so right, and I would not at all be surprised to find that I have MGD or atrophied glands.

    Naming our problem, communicating it to doctors, and being able to discuss it is a huge step forward, so I very much appreciate your efforts, Rojzen, and everyone else's input here.

  22. #22
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    I would love to find myself wearing some kind of lens to prevent the sensations I feel in my eyes. My ultimate goal is to open up my tear ducts a bit so I can drain these excessive tears. But, for now I need to keep myself cauterized. I would so appreciate the opportunity to manage my discomfort without all this blotting I am always doing. After four years I must say I'm tired of it.

    Regarding a lens, I was so contact lens intolerant I cannot even imagine finding comfort in a lens. I was intolerant to semi-hard lenses when I was a teenager...I can't imagine trying it now. So, I've not bothered to try. I'd have to travel for this, too, and it's just not that easy right now.

    Knowing full well I will always be a dry eye patient, my goal in all this would be to manage my dry eye comfort with a lens, compresses and no cautery. I would love to improve my washed-out, weepy crying look, and be able to wear a bit of eye makeup as well.
    Never play leapfrog with a unicorn.

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    if gas permeates - (stop the menthol)

    Great to know from Rebecca that RGPs may, in fact, potentially stop the menthol sensation. . .I share the background of those here who previously suffered from lens intolerance (long before full-blown DES), and I share with them, as well, the wonder at how our beleaguered eyes could handle lenses of any kind. . .all the while understanding how sclerals have been an absolute godsend for those with abnormal and abnormalized corneas. . .

    What amazes me is that lens specifically designed to allow air through them (or am I misunderstanding gas permeability?) could provide protection from the windy sensation. . .Perhaps, as Rebecca says, it is a question of degree. . .For outdoor-level winds, wraparounds and other protective eyewear would seem indispensable, even with sclerals on. . .

    Paradoxically, I would have thought that soft bandage lenses would have cut down on menthol sensation. . .and yet when I wore those, my menthol was the worst ever. . .Go figure (:^). . .

  24. #24
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    Rojzen,

    Maybe we need to take a road trip to Boston to find out...

    D
    Never play leapfrog with a unicorn.

  25. #25

    Thumbs up Perfect description

    Yes, I also have this sensation. It's worst in my left eye, which is my more problematic eye. When the sensation is at it's worst, I'm usually having constant tearing and stinging as well. I've had this symptom in both eyes for years whenever the wind blew, especially in winter. I thought it was just me.

    One less "just me being weird" symptom to check off the list

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