All of a sudden

Hi.  I was wearing contact lenses for a few months and they were VERY comfortable.  The only reason I remembered to take them out was because it was a novelty.  Then all of a sudden I started having to blink really hard to get tears going in my eyes as they felt like they were stuck to my eye and it was itching quite a bit so I had to take them out.  I've not worn my lenses for quite a while now but I was diagnosed with conjunctivitis.  I took the drops for a week, went back and my optician said everything was fine and that I can start wearing my lenses again.

I started wearing them again and I got the same kind of pains and so I went back and he once again said everything was fine with my eyes.  I haven't worn them for over a month now but even WITHOUT the contacts my eyes are always feeling really tired and dry.  I've never felt like this before with my eyes been dry.  Do you think I should go to someone more specialised or do you think he will be qualified enough to spot something if he owns his own opticians?

[John C Hagan III, MD, FACS, FAAO]

Both your contact lens intolerance and your symptoms of tired and dry could be due to dry eyes. You should see an ophthalmologist (Eye MD) for a comprehensive medical eye examination, when you have your exam ask them to do a "Schirmer test", that's a relatively simple test that measures the amount of dryness.

You may not be able to go back to contact lens and you may need to go on dry eye drops (artificial tears)

This is a previous post about dry eyes:
a Schirmer test of zero indicates that you have severe dry eyes. I'm assuming from your posting that you have tried both preserved and unpreserved artifical tears, gels or lubricating ointments at bedtime, environmental modification, etc. Don't discount eye drops. There are over a 100 different brands of artificial tears and they can't all be lumped together. Sometimes one will find the perfect drop. Because the problem is so prevalent the pharmaceutical compies are coming out with new products all the time. Some of the newest are Systane preserved and unpreserved drops and Optive drops.

If you took Restasis you have used the best prescription medication. A "trial" of Restasis is a minimum of 8 weeks of therapy using one drop in each eye twice/day. Because of the way Restasis works, it takes two months to "start working". I have found that many patients use it for a few weeks then conclude it won't help. The medication often stings when therapy is begun--it usually gets better by week three or your Ophthalmologist (EyeMD) can prescribe a mild steroid drop for a couple of weeks. If you did not take for 8 weeks you need to restart therapy.

If you have tried tear duct plugs you should have had all for tear duct openings (puncta) plugged with a permanent plus (not a disolving one). Usually just the lower lids are done with mild dry eyes. If your problem is as bad as you say, you and your ophthalmologist should discuss permanent closure of some or all four of the tear duct openings with cautery.

Additional things that can help include a diet rich in fatty fish (eg salmon, sardines, etc). Fish oil taken by mouth usually 2 to 4/day has been show to help some patients. In addition there are non-prescription pills for dry eyes available at most major drug stores or by direct order from the companies. Thera-tears is probably the most widely used. You can use any search engine to pull up the websites of the companies that see these.

In dry eyes associated with corneal damage, moisture retaining goggles are used for sleeping. Be absolutely certain you do not sleep under a fan, heating outlet or situation where air moves over your face during sleep. Make certain you home is humidified in the winter, put a humidity gage in the bedroom. If you cannot maintain a 50-60% humidity put a room humidifier in the bedroom.

If you are menopausal or post-menopausal be sure you and your gynecologist maintain optimal hormonal balance. (Many women with dry eyes have dry mouth and dry vaginal canal). If you have joint pain have that evaluated to be sure you don't have Sjorgren's syndrome. Many medications eg antihistamines can make dry eye worse. You might review your medications with your ophthalmologist.

If you reach a point of exhausting all the above see an ophthalmologist that specializes in "Cornea and External Disease". This is their special area of expertise.

Keep digging and moving forward. I suspect you have not exhausted all the ways you can be helped.


JCH III MD  Ophthalmology