Post Salzmann's Nodulectomies Double Vision

Hello, I basically have messed up corneas.  Had mixed astigmatism, then LASIK, which worked ok.  Anyway, a few years ago, I started losing night vision due to Salzmann's nodules.  Had the nodules removed from both eyes this year (one eye in November and one in April) and now am going through trying to get a new glasses prescription that works all day.  My newest (third) distance prescription works ok during the day.  However, in the morning, I often find that it is too strong (or weak?), and causes my eyes to feel "pulled".  In fact, I can often see clearly in the morning without my glasses and can see car license plates and traffic lights as single, correct images--not crisply sharp, but single images.  But once I put the glasses on, I often see duplicate images of the lights in a vertical pattern.  At night, I know my pupil opens more and some of my residual mixed astigmatism comes back and triple, clustered traffic lights can appear.  I have mild blepharitis.  Any ideas why my vision would fluctuate so much in the morning?  I have mild/moderate dry eye and put drops in several times a day.  The new prescription I am wearing was prescribed only a couple weeks ago.  The one prior to that was found to be too strong on the astigmatism and distance prescription in both eyes, so it seems my eyes are continuing to heal somewhat.  Is it possible that I will need more than one prescription, depending on the time of day?  Also, for the first week or so after I got my new prescription, I was able to read text on the computer very sharply.  But again, a couple weeks later, the glasses seem too strong at that distance.  I do not wear bifocals.  However, I was measured to be +1.25 in both eyes.  My current glasses prescription is OD:  sph (+.25) cyl (-2.25) axis (010).  OS: sph (-1.00) cyl (-1.25) axis (005).  Any insight would be helpful.  Thanks.

[Houman Vosoghi, MD]

Anytime you are dealing with irregular corneas, it becomes difficult to speculate what is causing what in terms of your vision.  The only thing I could add is you may want to try putting in Muro 128 OINTMENT (not drops) in your eyes at bedtime and see if the vision is better in the mornings.  This is a salt containing ointment that may help in some people with morning problems with their vision due to cornea issues.  A generic form is also available.  Also, make sure you are seeing a cornea specialist for your eye care.

HV