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Is there a doctor online who has significant experience

treating dry eye and chronic...
Is there a doctor online who has significant experience treating dry eye and chronic eye inflammation?
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Answered in 5 minutes by:
12/19/2011
Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 11,673
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
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Dr. Rick :

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

Dr. Rick :

only part of your "already tried" post was shown online. Could you copy/paste it here again please?

Customer:

I've been dealing with dry eye and inflammation for over 3 years now. My optometrist has had me on several types of steroid drops, which usually do alleviate the inflammation, only to have it recur as soon as I stop using the drops. He has also sent me to another specialist who inserted punctal plugs, which helped me for a while. However, the third time around they did not help and I ended up back on steroid drops and have been relying on them on and off ever since.
Very recently, while on Pred Forte, I ended up with elevated ocular pressure and had to go off them and later switch to a weaker steroid, Alrex, which does not seem to be working. Certain artificial tears help initially with the burning feeling, but somewhere along the line they all seem to end up making matters worse.
I get allergy shots for dust mites, tree pollen and mold and have tried several types of allergy eye drops, but none of them give me relief. I've tried all the common sense suggestions - warm compress, humidifier, staying out of sun and wind, etc. - and still my eyes are constantly red and irritated. Where do I go from here?

\(°_o)/¯

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Since you are a steroid responder (get high eye pressure from being exposed to steroids) I expect that you will start to have problems with glaucoma on Alrex also.
The first thing you should do, especially since you are at risk for glaucoma with steroid use and you have been dealing with this issue for such a long time, is stop being treated by an optometrist. You should find a corneal/external disease specialist and have all your eye care done by her alone.
Does this make sense to you?
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Customer reply replied 6 years ago
it does make sense, because this has been going on far too long and I gree I do need to stop using the steroid drops.
Since you have been dealing with this for so long I am sure that you have been treating any underlying blepharitis you may have. This is very important. If you have not been treating this, let me share with you the therapy I prescribe to my patients to deal with dry eyes, allergies and blepharitis: (I know you may already be aware of this :o)....
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.
In your case, if you have already tried all of the above treatments you should see a corneal specialist.
It is my belief that the steroids you are using are just masking the symptoms and your underlying cause(s) are possibly, undiagnosed, and definitively untreated.
Does this make sense to you?
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I agree that the steroids should be stopped as the risk of blindness from glaucoma is too great to continue with them.
It has been my pleasure to help you. Have a good night.
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Let me know if there are there any other concerns or issues you would like to discuss on this topic.
If you have a chance drop me a line and let me know how things turn out.
Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 11,673
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
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Customer reply replied 6 years ago
Wouldn't blepharitis cause my eyelids to be crusty? I don't think I have that problem, although my eyes are redder around the margins.
No. You wouldn't necessarily have crustiness that you can actually see. While evidence of blepharitis would be easily seen with a slit lamp exam, at home you might not notice anything more then redness and possible swelling along your eyelid margins.
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Dr. Rick
Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 11,673
11,673 Satisfied Customers
Experience: Ophthalmology since 1994 with Retina sub-specialty interest

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