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Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7925
Experience:  Ophthalmology since 1994 with Retina sub-specialty interest
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I have severe dry eyes. . . Restatsis wasnt doing its job

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I have severe dry eyes. . . Restatsis wasn't doing it's job after several years so I had tear plugs inserted and over-the-counter preservative free eye drops which, again, over time doesn't work that great. The plastic tear duct inserts don't last forever so, as of right now, I have 1 plug and 1 permanent closer done, have slight corneal abrasion in one eye. Pain in one 1 for years, I do not want steroids as I had severe adverse reations and it's documented that I can't have this. Also, I wear a very heavy prescription (-9) and have nevus in the eye that hurts all the time, 24-7. What can I do to get some relief and I'm 60 yrs....
Submitted: 2 years ago.
Category: Eye
Expert:  Dr. Rick replied 2 years ago.

Dr. Rick :

Hi. I'm online and happy to answer your question today.

Dr. Rick :

Well, first I would try some home therapy to combat any additional issues that you may have going on in addition to your dry eyes such as allergies and blepharitis.

Dr. Rick :

When it comes to allergies it is almost impossible to pin down the offending agent(s) and, therefore, treatment needs to focus on controlling the symptoms. Dry eyes are very common and can be improved by a stepwise series of therapies. First, the use of natural tears 4-6+ times/day to augment your natural tear production, if this doesn’t work then you can try temporary punctal occlusion of the lower puncta, then, if needed, temporary occlusion of all 4 puncta then, if indicated, surgical ( non-reversible) closure of the puncta. The openings to your tear drainage system are called puncta and you have one opening on each lid, near your nose.


 


Blepharitis is a condition where glands in the eyelids are not functioning normally. They become plugged and instead of putting out their normal clear, oily secretions, they put out thick, toothpaste like gunk. You may not be able to see this “gunk” yourself, unless it is really bad, but it shows up clearly on slit lamp examination.


 


The best treatment for this condition daily lid scrubs combined with warm compresses. I like to use baby shampoo for lid scrubs. In the shower, place the shampoo on your index fingers, close your eyes, raise your eyebrows (to stretch the skin on your eyelids) and scrub back and forth along your eyelashes for 3 to 5 minutes. The hot water in the shower helps to soften the plugged oils in the glands while the mechanical scrubbing with your soapy fingers removes the oils.


 


Baby shampoo lid scrubs will also help to wash away allergens and stimulate tear production, thereby addressing all three of your issues. Remember, this is not an instant fix. While you are waiting for the lid scrubs to have affect you can use over the counter allergy pills such as Travist, dimetapp or Zyrtec.


 


Should your symptoms get worse, your vision become significantly affected or things just not get better in 3 weeks or so you should have a complete eye examination by your local ophthalmologist to look for other, less common, causes of your symptoms.


 

Dr. Rick :

In your case you have already done the recommended treatment for dry eyes.

Dr. Rick :

So. If this home therapy, punctal occlusion, restasis and steroid drops haven't solved your problems the next step, in my mind, is surgery. What would I recommend? A temporary lateral tarsorrhaphy, using either tissue glue or a removable drawstring suture, should really help your severe dry eye issue. If this temporary tarsorrhaphy gives you substantial relief it can be converted to a permanent tarsorrhaphy fairly easily. Here is a very good article that discusses the various techniques used in this procedure:

Dr. Rick :

http://archopht.ama-assn.org/cgi/content/full/120/2/187

Dr. Rick :

Does this make sense to you?

Dr. Rick :

I see that you are offline. I'll switch over to the Q&A system. This system works a lot like 'text messaging' but an email is sent to each of us anytime something is posted to this thread. We can continue to work on your question there..... :)


 

Expert:  Dr. Rick replied 2 years ago.
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Expert:  Dr. Rick replied 2 years ago.
Let me know if there is anything else you would like to discuss pertaining to this issue.
Customer: replied 2 years ago.
I see a specilist for my eyes and the prescriptions that are prescribed to me are all the "tier 3 or 4" on your insurance. Also, I need eye drops that are for sensitive eyes and no preservatives. I live in a rural town and believe me, there's not much available products here. So, I was hoping that you could have some other advise. Thank you as your very intelligent on the answer for not actually seeing the dilated eye and from the info that I gave. I just feel I need to take my drug 2012 Formulary Guide with me to appointment so that I can get a tier 1 drug choice instead of all this top of the line, tier 3 or 4 drugs, i.e. Nevanac that I'm currently trying. And it's always drops that have preservatives, like propel glycol which is actually a drying agent (I call it industial antifreeze).
Expert:  Dr. Rick replied 2 years ago.
I like your description of Propel Gylcol :-) I'll have to remember that one.

And, don't get me started on the different tier's that insurance companies use on their formulary which,in my opinion, are just a way to maximize their profits and decrease medical care. It sounds like a great idea to take the formulary guide with you to your appointments -- it's just a very statement about how medical care in our country is being controlled more and more by those who hold the purse strings.

It sounds like you are getting excellent care with the specialist you are seeing. I wish you the very best.

Let me know if I can be of any further service in the future.

Take care.
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7925
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
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