Please...help with severe dry eye pain!

[MitcheeLN]

Please....I really need help.  I'm at my wit's end.  I have persistent, constant eye pain that is being attributed to severe dry eye.  Where to begin?

36 years old.  Retina dettachments in both eye (2 and 3 times each), surgery, laser surgery, cataract removed in one eye.  I've had dry eye for a few years, mild to moderate, always responded to eye drops.  Last December the dry eye really escalated and starting causing horrible pain.  The pain has just intensified since then.  In Feb I didn't think pain could get worse...it did.  In May, didn't think it could get worse...it did.  In August I knew I was maxed out on pain.  Wrong...it's worse.  I don't even know the words to describe the horrible sharp, stabbing pain I'm experiencing.  My eyes hurt when they're open, when I close them, when I move them from side to side.  You probably get the message.

Been on Restatsis since January.  Take oral BioTear vitamins.  Have all four ducts plugged.  My favoriate eye drops are: Systane Ultra, GenTeal gel, Celluvisic, Blink, B&L ointment....use them frequently.  It even burns and hurts to put drops in.  I use a humidifier at night and just got one installed onto the house HVAC system.  I use wam clothes on my eyes sometimes, I use cold packs on my eyes sometimes.  I wear sunglasses in my home and always when using the computer.

Oh, the headaches.  Migraine once or twice a month.  Tylenol, Advil, Aleve - use them all - don't provide much relief anymore.

I've researched the archives here to find something that I may have missed.  I don't know where to go from here.  My doctor seems to be out of suggestions.  I think, he believes, I'm making some of this up.  He does admit the my eyes are "drier than the saharra deseret."  Lately his only advice has been to try some different drops (gels and ointments) and use them more frequently.

I realize I'm rambling.  I'm trying to provide as much info as possible in the hopes of getting the best advice/suggestions as possible.  To say that this has impacted my daily life is putting it mildly.  I'm having trouble taking care of my two small children.  The pain gets so bad and I'm becoming an awful parent.  It's tough to plan our day because I never know how dibilitating the pain/eye strain is going to be.

Does anybody have any suggestions of something to try that I'm not already doing??  Anything?  I'll stand on my head and meditate if that will help.  Thank you.

[John C Hagan III, MD, FACS]

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. Eye drops for dryness are classified as preserved drops (individual vials that must be used within 24 hrs), preserved drops, gels and ointments. The preserved drops are more expensive and usually only help the small percentage of people that are really allergic to preservatives. Gels and ointments are normally used at night since regular tears won’t last all night.   There is also an over the counter spray for dry eyes called “Tears Again”.  Tears may need to be used as often as 6 times/day.

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.

Be sure to try Nature’s Tear’s Eyemist a spray for dry eyes that works for many people. It is available prescription.  http://www. naturestears.com/

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.

Ask your ophthalmologist (Eye MD) about Lacriserts. These were unavailable for several years and are now on the market by Aton Pharma. They are very tiny pellets of hydroxypropyl cellulose that are placed between the eye lid and the eye and slowly dissolve over 24 hours coating the eye with a moisturizing coat.  They are a prescription medication.

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.

See another corneal specialist.  THIS IS A COPY OF A RECENT POST LIKE YOUR QUESTION.

[Dr_Debbie]

Hi..

I have had severe dry eyes for approximately seven years now and can relate to many of your experiences. I have gone so far as to have my lower tear duct openings cauterized. One additional step you may take that you nor Dr. Hagan mentioned is to use first aid tape to tape your eyes closed at night to ensure you're not opening them partially as you slumber. Additionally, it helps to keep the moisture from your night med application on the eye.

Hope this is useful and best of luck with your problem.

Dr. Deborah Hedgecock

[tiggers]

I do hope you have also tapped into the dryeyeshop.com for more help.  

Tiggers

[John C Hagan III, MD, FACS]

-