Dry, Itchy, Red Eyes

I have been experiencing persistant dry, red, itchy eyes for about 5 weeks now. They appeared after a trip and i noticed them after i turned the air conditioner on during the plane ride back.

Within two days I was waking up with clear mucousy discharge and painfully itchy red eyes. I went to a local opthamologist (well kinda, turns out she wasnt a certified/educated opth, and im in Kuwait) I was put on a weeks worth of broad spectrum antibiotic drops that only made them worse. She concluded it was viral conjunctivitis, but i had no swelling or swollen lymph node in front of my ear. At two weeks i was put on a cortisteroid eye drop and antiboitic eye drop five minutes apart every three hours. I took those for a good two weeks, with minimal improvement.

I finally got into a real opthamologist last week and he examined my eyes and told me that i dont have any sign of infection and told me to discontinue use of the steriod/antibiotic as it has dried my eyes out. He got me to use natural tears that are preservative free and they help alot during the day. But at night i have trouble sleeping as they dry right out again, and in the morning my eyes are still itchy and red and mucousy in the inside corners.

Am I going to have a problem like this forever? Are there some tests to figure out just what the hell is going on with my eyes? Can dry eyes really just come on over night like that? Should I be worried about any other kinds of viruses or bacterias that the antibiotic might have missed during immediate treatment?

Im so lost and in pain right now and I m thinking that i need to leave the middle east and see a doctor statesidethat knows what the hell is going on. Im getting scared about my eyes, my appearance, and vision loss.

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

Here is a recent post on dry eyes:
JCH III MD

General Information on 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. Improvement often continues for up to 6 months.

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 formula for dry eyes 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. Run the A/C or heater of your car through the vents on your feet not in your face. Long car or plane trips put your tears in every couple of hours.

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. A final new treatment that they can often do is “Autologist Platelete-rich plasma” therapy. This uses eyedrops made out of your blood products. (reference Ocular Surgery News: November 1, 2007 page 46  lead author Jorge Alio MD.

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