Fml used, dry eyes not recovering

[Mreman]

Hi, i recently used fml for a week and stopped due to extreme eye dryness. I alredy have punctual plugs and my doc wanted to reduce some inflamation. I went to my doctor and he said that the dryness will gradually get better over the next 2 weeks. Its been a month and my dryness is still much worse then it was after i had plugs inserted and before using fml. Is it at all possible for the dryness to be perminent? Also i was told it may be that im sensitive to the preservatives in it, if it is an allergic reaction to the preservative or any other ingrediant is the resulting dryness also perminent? thank you doctor

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

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[Gerri55455]

Still thinking on this issue, still coming back to this answer. I mean, here is a patient who uses a medication whose instructions are as follows: "Instill one drop into the conjunctival sac two to four times daily for two weeks, then one drop two times daily for two weeks. The dosing of FML® suspension may be reduced, but care should be taken not to discontinue therapy prematurely." The injunction "not to discontinue therapy prematurely" is repeated several times in the package insert and also on the package itself. Such instructions are not given for another common steroid, i.e. Loteprednol (Alrex or Lotemax). And it so happens that this patient uses this medication for a week and … well… discontinues therapy prematurely. I whole-heartedly agree, speaking more from experience than from blind faith in any specialist's advice that steroids are not for chronic dry eyes. But how does the use of FML for a week constitute "chronic steroid use"? And why bother advising patients to not discontinue therapy prematurely if discontinuing therapy prematurely has no consequences and no bearing on anything at all?

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

My answer is unchanged. FML is a steroid and its benefit if any for dry eyes should be apparent within a week and chronic steroid use is not a component of chronic dry eye therapy.

JCH MD

[Gerri55455]

Dr. with all due respect, there is a reason why the instructions on the FML medication information sheet and everywhere on the FML container itself expressly state that "Care should be taken not to discontinue therapy prematurely." Indeed, FML therapy is supposed to be 4 weeks. So stopping it after just one week would cause discomfort that may not have bee there to begin with. Otherwise, why else would there be need for such a specific injunction?

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

Use the search feature to read the many many posts about treatment of dry eyes. If the plugs were going to help you should see something good by now. You are a great candidate for Restasis and Enteric coated fish oil.

JCH MD