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Dr. Dan B.
Dr. Dan B., Board Certified Ophthalmologist
Category: Eye
Satisfied Customers: 3343
Experience:  Eye surgeon experienced in cataracts, glaucoma, retina & neuro-ophthalmology
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My left eye gets dry, eye lid gets puffy at nite time, in the

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My left eye gets dry, eye lid gets puffy at nite time, in the morning my eye doesnt even open, there is lot of dry crust on eye lashes. I have to use warm washcloth for few minutes to get it back to normal. My doctor thinks its dry eyes due to lasik surgery- i have tried all type of tear drops last 10 months including Restatis for past 3 months, Tear plus for 2 months, but with no cure.. Pls help me !!
Submitted: 6 years ago.
Category: Eye
Expert:  Dr. Dan B. replied 6 years ago.

This sounds very consistent with a dry eye syndrome. Now, I can guess what you're thinking. If my eyes are dry, why hasn't all of the artificial tears and Restasis that I've been using over the past 10 months helped me?

 

Dry eyes can be due to many different factors. Different medicines such as psychiatric medicines such as the ones you're taking, antihistamines, cold medicines and others can contribute to dry eyes. Cigarette smoke is a notorious cause of these symptoms as well. Allergies in the eyes can also contribute (make dry eyes worse). Some people have an innate deficiency in making their own tears (these people may also have other dry mucus membranes, such as their mouth, nasal passages, or genitalia). 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. Your symptoms sound very consistent with blepharitis. The reason why the use of Restasis plus all of the many artificial tears you've used have not worked to quiet your symptoms is because you haven't been treating all of the reasons for dry eye, meaning you have not been treating the blepharitis.

 

I would suggest you 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.

Just doing the artificial tears, hot compresses and eyelid scrubs alone would likely start to help you after three or 4 weeks--but remember it could take this long of doing it everyday before you see a significant effect, so don't stop it thinking it's not working.

Many people are started on Restasis either prematurely or incorrectly. It may be that you are a person that doesn't make their own tears very well and if so then you may benefit from continuing Restasis, which actually modulates a person's immune system to help them make more of their own tears. However, it may be that you may not even need it at all if the blepharitis is being correctly treated.

Because there are numerous reasons for dry eye, if not all the reasons that exist in one patient are treated, it can seem as though the ones that are being treated are providing no benefit. If you've tried these recommendations and still don't feel better then you should consider seeing an ophthalmologist for a dry eye evaluation.

 

Does this information help address your concerns? Does this make sense? Do you have any other concerns that I haven't addressed?

 

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My opinion is solely informative and does not constitute a formal medical opinion or recommendation. For a formal medical opinion and/or recommendation you must see an eye doctor.

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