Question for Dr. Latkany

[dryasadesert]

Do you know of any dry eye specialists in the Chicago area? I have an appointment with Robert Feder, who is the chief of Corneal and External Disease Services at Northwestern University Medical School, but would like to know whether someone else comes to mind. I have been contemplating flying to New York to see you, but given the need for follow-up visits, it would be helpful to speak with someone in the area first.

I would also appreciate any insight you have on my condition:
27/M
Healthy
No contacts
Diagnosed aqeuous tear deficiency (schirmer scores of less than 2 with plugs in) but likely have mild MGD as well. Have punctal plugs in lower two tear ducts. Trieds four plugs, but they make me weep within 30 minutes and irritate my eyes. As a result, my eye doctor partially lasered my upper two ducts in order to shrink them.

Have been on Lotemax qid for two weeks and restasis bid for two weeks (understand this is not long enough). I am having trouble with the regimen because it seems my eyes burn worse halfway through the day when I take the restasis and lotemax. I am not sure whether it is a reaction or not. The burning is localized to the outside portion of my conjunctiva (any reason for this -- conjunctivachalasis??).

Would a drop like optivar in addition to restasis and lotemax be helpful?

I am having difficulty tracing any cause to decreased lacrimal function -- i don't have sjogrens, have not had lasik or contacts, have never had eye trauma and I am otherwise healthy. I have stumped 7 opthamologists....any suggestions??


Thanks

[bassfan]

dryasadesert

I dont think Dr Latkany has time to read this Open Forum, so you'd probably get a faster response posting it in the forum with his name.

I cant say anything about Chicago but I can about Dr Latkany. I went to him once, Im about 5 hours away from his White Plains office. I got a lot out of the visit and have followed up with him a few times. He has spent at least 20 minutes on the phone with me knowing I probably wouldn't come back to see him. That said, I have an appt with him at the end of the month again. Anyways, if you aren't completely satisfied with your local docs (I sure wasn't) then by all means make a single trip to see him. I even paid cash because the stupid HMO wont cover him, which sucks...but I can't keep living like this so its worth it. Also if you haven't read his book, check it out too.

bassfan

[GeorgeT]

Hi,

Your problem is similar with mine. I have zero Schimer scores in both eyes, but TBUT is 10 sec. I use upper and lower plugs -flow controllers. I have MGD/ocular rosacea. It's very difficult, and now I am looking into moisture chamber glasses. I also had many failures with restatis.
Could you tolerate restatis?
BTW, you'll find a few good doctors on the forum.

All best,

George

[Rebecca Petris]

Hello dryasadesert and welcome.

This forum (and all of the others except the Q&A) are patient discussion forums. If you would like a response from Dr. Latkany please post in his Q&A forum after reading the guidelines.

Glad you found us, and hope you find all the info you need here!

[Rebecca Petris]

...By the way...

How long have you had this condition? Was it sudden onset or gradual?

Any medications (ocular or systemic)?

Any environmental changes around the time of onset? New home, new job, new office, new car, anything like that?

[dryasadesert]

It has been a problem for close to 7 years, but it is clearly getting worse. I am not on any medications other than the Lotemax and Restasis, which I don't appear to be tolerating well. I was on restasis for 3 months at one point and it didn't help much...it was pretty strange in that my eyes wouldn't hurt after putting it in but would sting really bad midday so I assume I am reacting to it.

Other than that:
No systemic medications
No allergies
No eye trauma
Eat healthy
Drink a ton of water
Exercise

That is why it is somewhat perplexing to most doctors I see.
I reposted my initial post. Thanks, I didn't see that forum when I first signed up.

[GeorgeT]

Hi,

Could you explain your 7 year symptoms? I also have a history of symptoms: tearing in windy /cold air for many years. I have the same problem with Restatis. It starts burning after 3-4 hrs after instillation. How often are you using drops ?
Are you using full plugs or flow controllers?
How long did you use Lotemax?
Thanks,

George

[Rebecca Petris]

Sorry for the persistent questions but just trying to do some detective work here.

You mentioned you "likely" have mild MGD.

Did any of these 7 stumped ophthalmologists tell you your tear break-up time? Did any of them get hands-on and squeeze your meibomian glands and comment on the results?

Just the guesswork of a fellow patient here, but my thought would be that either you have a very unusual case of primary aqueous deficiency or you've got undiagnosed/untreated MGD. My money would be on the latter because it happens to so many people. Usually they start getting at the truth by about the 5th doctor, but certainly not always. I know an optometrist in Peoria with a ton of dry eye in her practice and I know she sometimes sees patients who have been to multiple ophthalmologists who have failed to diagnose their MGD. It seems like a basic thing, but we have a whole community here who can attest to how frequently it is overlooked or misdiagnosed.

However, there are always some very rare hard to pin down cases too. At our conference last year we had a lady whose meibomian glands were destroyed by mold that grew in her brand new car due to an improperly fitted windshield. Hence questions about environment.

[bassfan]

At our conference last year we had a lady whose meibomian glands were destroyed by mold that grew in her brand new car due to an improperly fitted windshield.

What the heck?!!!

[Rebecca Petris]

That's right. You may imagine how much detective work THAT took (since she did not know at first that the windshield was not completely sealed). Moisture seeped into the car. In the end it was proven. Cultures and everything. I think she may even have gotten a judgment against the manufacturer. But by the time it was figured out, her MGs were toast - completely atrophied - and her lacrimal glands not much better.

[liz56]

That's right. You may imagine how much detective work THAT took (since she did not know at first that the windshield was not completely sealed). Moisture seeped into the car. In the end it was proven. Cultures and everything. I think she may even have gotten a judgment against the manufacturer. But by the time it was figured out, her MGs were toast - completely atrophied - and her lacrimal glands not much better.

Yikes! What kind of car was it? I have an ulterior motive for asking-- my Subaru windshield lets go a high-pitched sound when it is really windy, and I have worried for a while about the seal.

[calli66]

In the end it was proven. Cultures and everything. I think she may even have gotten a judgment against the manufacturer. But by the time it was figured out, her MGs were toast - completely atrophied - and her lacrimal glands not much better.

Yikes, now I'm worried. Was that some unusual kind of mold? Because right now we're doing remodelling--tearing up floor in our adobe (old, dirty, moldy) house, and my eyes are really itching. I've never had that before.

C

[Julie1]

I'm worried too. I had some mold in my shower, and my landlord only covered it up with caulk. He did not even bother to scrape away the old mold, just covered it up. I can't see the mold (except for a few spots) anymore -- it's completely covered. I know that mold is still there b/c I saw him cover it up instead of scrape the mold away first. He said that this was the correct way when I questioned his technique.

Should I wear swimming goggles in the shower?

[brudni]

Hi I am in the midst of figuring out what is causing my inflammation / dry eye but I have a very complicated case. I see my rosacea has spread to my eyes but because I had episclertits that turned into sclertits after giving me Vigamox my doctor put me on Pred Forte and I have been going on and off it mostly on unfortunately. Trying to just do one dose today.

I am also on Restasis. The doctor who is helping me saved my eyes 19 years ago when I had Stevens Johnsons syndrome which really complicates dry eye syndrome as my cornea is full of scarring from that awful allergic rection and I already had some but not inflammatory dry eye or episcleritis before this year.

I have gone through autoimmune testing and fortunately everything came out negative but not being able to get completely off of Pred Forte worries me; I have been on it since May which is also allergy season. I am pursuing allergy, dermatology, and opthamology solutions as with rosacea and allergy they don't know what is causing thei inflammation which started so suddenly as episcleritis is usually a symptom of an autoimmune disease.

The dry eye remedy book and this site reallly helped me and especially the Panoptyx which I got through my eye doctor. Through my eye doctor I was able to get them to order special high index ones. They don't fit perfectly as I was limited to 1 or 2 styles but I can be outside. My dry eye was so bad and scary with the episclertits any breeze was a threat to my eyes. Thank goodness they make Panoptyx.

However, I am seeking another opinion on Wednesday with Dr. Macsai who is in the dry eye yellow pages. I see the rosacea bumps have spread to my eye lids and I am the one who mentioned rosacea to all the optometrists and opthamologists. I can't help feeling my tear ducts are really plugged from it. They are so much better after doing the rice bag heat treatments followed by massage and cold nonpreservative drops, but it doesn't last long. I need to have a doctor who looks at everything and really takes their time.

I learned more from this site and the Dry Eye Remedy book plus my own research than from the physicians.

Let me know how your doctor is.

[Joey]

dryasadesert, it seem like I have very similar problems to you. I have been on Restasis for a couple days, and i can't get past the burning in the afternoon. Plus my eyes are all red and irritated. My eye doctor did the AMT surgery on me a year ago, thinking cinjunctivo chalasis was the proplem, well it wasn't. I know this because my eyes still bother me and are red. So now he is thinking it's MGD. i don't know if I agree with him. He seems to always be changing his mind.

[dryasadesert]

The doctor I saw was not too sympathetic. He plugged my uppers because my Sch. tests were 1 and 2, which I already know. I have had these plugs before and they have not offered any help, but he wanted to do it anyway. I have pure aqeauous deficiency (which I knew) but he couldn't attribute it to any root cause. He said typically they don't "go on fishing expeditions" to find the root cause.

He offered no suggestion as to why restasis hurts several hours after instillation for me. Looks like I am off to NYC to see Dr Latkany.

[Rebecca Petris]

If you (and Dr. Latkany) will forgive my facetiousness, whaddya suppose the odds are he'll agree that you have "pure" aqueous deficiency with no traceable cause....!

[dryasadesert]

I agree...I felt like jumping out of my chair and punching him.

[sazy123]

I have had these plugs before and they have not offered any help, but he wanted to do it anyway. I have pure aqeauous deficiency

I find it strange that you have pure aqaeous deficiency but plugs were of no help. Are you sure you dont have some MGD going on as well, that wud explain plugs not helping. I mean just coz they havent diagnosed it doesnt mean you dont have it, as docs often dont know much about it and the tests to diagnose it are not great. In the UK, most dont even test for it, god knows why when studys show 80% of dry eye is evaportaive.