Hello and thank you for your question.
I can certainly understand your symptoms; many of my post-operative cataract patients complain of similar symptoms. Given the fact that you have seen several ophthalmologists who have not identified anything wrong, you almost certainly are having dry eye symptoms.
Having a dry eye is a very common problem after having eye surgery. The reason is because once the cornea has had an incision, any incision, its ability to maintain its own hydration is less than what it was before. Many post-op cataract patients have difficulty with dry eye symptoms after cataract surgery, many for several weeks, but most for 1-3 weeks with resolution. Dry eye can cause all of these foreign-body symptoms as well as burning, stinging, irritation, tearing/watering and a dry sensation.
It looks as though you are using Systane ultra artificial tears and restasis right now. Unfortunately there are numerous causes of dry eyes and if they are not all specifically addressed, then it often times seems as though the treatments that you are doing that are correct for other forms are not working, and then these get abandoned out of frustration.
First of all, Restasis is used for persons with dry eyes who don't make their own tears well enough. Sometimes Restasis is started for people that don't really need it. If your ophthalmologist started you on this, then I would assume he/she did the necessary testing to determine that you do, in fact, need it. Second, artificial tears such as the Systane ultra you are taking are definitely a mainstay of treatment. A couple of things to know about artificial tears is: 1. If you are using tears that come in a bottle, then of necessity there are preservatives in them; therefore you shouldn't use this kind of tears any more than 4-5x/day becaues the preservatives in them can start to irritate the eyes after 5x/day (You can use preservative free tears 30 times/day and it won't hurt your eyes); 2. You need to be consistent in using the tears; if they are only used when you feel like you need them, they often won't work effectively. They need to be dosed consistently at least 4x/day to be effective.
An other source of dry eyes is eyelid inflammation. Many people have an inflammation in the eyelids called blepharitis which causes the tear film that is supposed to coat the front of the eye to not function as well, and then the eyes dry out. People with blepharitis have morning tearing, burning, and often eyelash mattering. Their symptoms get better as the day progresses, but then they get intermittent blurring when they use their eyes heavily in activities such as reading, watching TV, computer use or driving.
Because blepharitis is so under-diagnosed and the treatment for it is relatively benign, you might consider starting this treatment, while concurrently continuing artificial tears. In order to treat blepharitis, everyday in the morning you should do two things: 1. hot compresses and 2. eyelid scrubs. You should do hot compresses for 5-10 minutes over each eye at the same time. It should be as hot as you can tolerate without burning your skin, massaging the eyelids while they are on there. Then, use either commercially available preparations or a dilute baby shampoo solution to scrub your eyelashes on all 4 eyelids. The commercially available preparations are called Ocusoft or Sterilid which are both over-the-counter eyelash scrubbing treatments. These cost more money but are quicker to use. Otherwise, the cheaper alternative is the dilute baby shampoo (4-5 drops Johnson's shampoo in 1/4 cup warm water), you will take the wipe (or dip a qtip in the dilute baby shampoo solution) and use that to scrub right on the eyelashes of each eyelid for 15 seconds. That will take 60 seconds when done to all 4 eyelids. The scrubbing is done right on the eyelid margin, where the eyelashes come out. After that, just splash some water on the eyes and you're done.
It does take about 3-4 weeks of doing this consistently every day before it really kicks in, so don't stop it thinking it's not working. Also the eyes are still significantly dry during this 3-4 weeks so use the artificial tears you bought 4x/day in both eyes (one drop per application). After 4 weeks you should be able to start tapering off of the tears to as you need them.
Flaxseed oil is also a good oral supplement to dry eyes, as is fish oil.
I would recommend these modalities of treatment. Does all this make sense and did this help you with your concerns?
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