Dry Eyes: Restasis? Punctal Plugs?

[Susan12345]

I wrote on the cataract forum about all my problems with the ReStor multifocal IOL's.  My doctor said basically there's nothing that can be done about them, but he can at least help with the dry eyes (presumably resulting from the astigmatism repair I had with the cataract surgery).  He mentioned punctal plugs, but after my surgery I can't say I'm eager for anything more that's even slightly invasive.  Anyone have good luck with them? I haven't asked him yet about Restasis, it's advertised everywhere, yet incredibly their own website says there's only a 15% success rate compared to 5% with placebo!  Is it best just to stick with the OTC liquid tears-I've tried various brands, none work that great.  Susan12345

[JodieJ]

Then I must be one of the fortunate 15% who benefits from Restasis.  I was given a prescription last year to treat inflammation from an allergic reaction to an antibiotic ointment following eye muscle surgery.  I was only supposed to use it in my left (operated) eye, but there was so much product in those little disposible vials that I put it in both eyes.  Coincidently, it was the time of the international film festival in my town, when I indulge my passion for foreign movies by seeing about 40 of them in two weeks.  In recent years, my eyes had become so painfully dry by the end of the fest that I could barely watch the final film (and those OTC drops really didn't help.)  But last year with Restasis, I could actually wear my contact lenses comfortably during the festival.  I don't think that the manufacturers of Restasis would use my testimonial, but I already have my script in anticipation of this year's film fest.

My sister has gone through several pairs of punctal plugs, all of which have gotten expelled after a short time.  But I think they work well for some people.

[waterhog]

do you think that is what happens when you get to a certain age that every thing dry up? I ask because I have dry eyes also a dry nose and I don't cough a lot as there is never anything on my chest
from waterhog

[Susan12345]

I had "astigmatic keratotomy", I think that's probably the same thing as limbal relaxing incisions.   But I went to another doctor yesterday and he says I don't have dry eyes at all!   The doctor who did the surgery, while claiming that his surgery shouldn't cause dry eyes, said my eyes were very very dry.  He didn't do the 5 minute tear test, just about a 10 second one.  The doctor I saw yesterday said he would do another exam (he didn't do the 5 minute tear test either) in a couple of weeks, but I should be off all eye drops for 3 days 1st.  I think he thought I was a neurotic woman focusing on my eyes and told me to just stop all the OTC drops I've been using.  All I know is my eyes sure FEEL dry.   How can 2 doctors see such totally different things?   It's not like my surgeon just needed a new Porsche, there's always a huge waiting list for everything at my HMO, no need for them to do unnecessary procedures.  When I told the doctor I saw yesterday that my eyes were so much dryer in the morning he asked if I sleep with my eyes open?!!    I don't THINK so, but  I live alone so I wouldn't know. All I know for sure is that I never used or needed eye drops before my surgery, could cataract/astigmatism surgery possible make you sleep with your eyes open? I don't know what to believe about anything any more.  This doctor thought Restasis was great, said he would prescribe that if I really did have dry eyes.

[JodieJ]

Didn't you have limbal relaxing incisions?  They can definitely cause dry eyes (although they usually don't).  Hope that someday soon you'll go see another doc for a second opinion about all your vision problems.

[Susan12345]

Well my eye doctor seemed to think punctal plugs were the way to go so I tried the temporary collagen plugs.  They were horrible!!!!!!.   Made my dry eyes much worse.  Thank goodness I didn't try the long term ones.  I keep trying to figure out why it would make things worse, the only thing I can think of is that I'm allergic to something in them.  Collagen is an animal protein, anyone know what they make the plugs out of? Cows? Pigs? Yuck.  I'm not allergic to any meat, but then I never had any put in my eyes before!  When I e-mailed my doctor to tell him the plugs had made my eyes worse, all I got back was a note from his assistant that the plugs were temporary.  Well I knew, that, I wouldn't have agreed to try them otherwise!  I've got an appointment with another doctor next week, hopefully he'll have a better suggestion or at least do some more tests to see what's causing the problem.  My doctor claimed the eye surgery shouldn't be causing the problem, mighty coincidental that I never had the problem until after having the surgery.    I am so frustrated!!!!!!!!!!!!!!    Susan12345

[Forum-OD-MP]

i'm not personally a big fan of punctal plugs.  restasis does work IMO, but only for people with reduced lacrimal gland production.  it is my opinion that lacrimal gland dysfunction is not a very common cause of dry eye.  the more common cause IMO is eyelid gland dysfunction (meibomianitis, blepharitis, etc).

the solution for some of those with eyelid dysfunction is emollient eyedrops (vs "atrifical" tears).  the 2 OTC emollients are "soothe" and "refresh endura".  maybe you should try one of those...

[blue92]

You are correct, everybody is different and what may work for me may not work for others. Today I spent the day outdoors without any dry eye symptoms whatsoever. Each day is different, but as I mentioned, things are improving. I do want to mention that I'm very careful with my eyes and do take precautions because in some instances it takes very little to aggravate my eyes. I had Rezoom implants. The jury is out. I have ghosting and glare, but no halos. I hope the ghosting will subside as my dry eye symptoms get better. If not, then I'll have to find other alternatives. One step at the time. I don't want to do anything until my eyes are fully healed. The surgery was uneventful and the placement of the lenses are right where they should be ( per ser second and third opinion). My doctor has been very cooperative and is working with me to resolve any pending issues. The only question I have and it raises some concern is the fact that I do not see too many positive comments about Rezoon and Restor. It makes me wonder about the validity of the research and their claims; although, I have to say, that in terms of near and distance vision my eyes have adjusted quite well. I hope my issues are dry eye related.

[JodieJ]

Your post makes a lot of sense.  Since there are multiple causes for dry eyes, the same treatment shouldn't be expected to work for everyone.  I'm glad to learn that your condition is improving.

Blue92, your difficulties seem very similar to those of another woman who posted here a couple of months ago.  She suffered terrible pain for months after receiving ReStor implants, and she reported that Restasis actually made her symptoms worse.    Your treatment recommendations might work well for others suffering post-cataract surgery dry eyes.

[blue92]

I also developed severe dry eye after cataract surgery (LRI for astigmatism). I was given every possible prescription drop (steroids) including Restasis. Restasis did absolutely nothing for, as a matter of fact I think Restasis made matters worse. In any event after six months of PAIN things finally got better. About six weeks ago my doctor asked me to stop putting prescription drops in my eyes and use only over the counter drops, take flag seed oil gels and use goggles as needed. What a difference!!! My eyes are much better, not there yet, but almost there. I use non-preserve drops once a day and sunglasses outdoor to protect my eyes from the wind. I use goggles very seldom. My vision is improving and the pain is subsiding. At one point  thought I was going blind. Good look. There is a light at the end of the tunnel!!!

[pmhettick]

After restor implants in both eyes, I too had severe dry eyes.  I tried drops, gels, and ointments but they didn't last and I couldn't use the ointment during the day.  I've been on Restasis for 3 weeks and they have gotten better.  I also take the omega 3 capsules for dry eye symptoms.  But the last 2 or 3 days I have noticed that the dryness may be returning.  I wear sunglasses religiously and avoid windy conditions whenever possible.  I'm afraid the plugs may be my next step, especially with the dry winter months yet to come.  I think one of the problems with being post menopausal is that the whole body dries up!