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My ophthalmologist says I have Dry Eye, but he isn't

My ophthalmologist says I have...
My ophthalmologist says I have Dry Eye, but he isn't specific about how bad my condition is. It seems to have suddenly started to become a problem only about 4 months ago, and I'm currently using Xiidra drops (for about 8 weeks now) and am following all the steps for care and treatment of my dry eye condition. I am now doing warm compresses twice a day, about 8-10 minutes each time, using microwave heated eye bags. My question is, after I've done about 10 minutes warming my eyes, and if i gently squeeze my eyelids, should I expect some liquid coming out of my tear glands, like getting some of it on my fingers? I get greasy fingers, but that's about it.When I apply the Xiidra drops, I get a lot of thick tears for about an hour or so, and it takes a while for my vision to clear up.I'm looking for an ophthalmologist that is experienced with treating Dry Eye. I'm 67, male, and now very concerned about my Dry Eye getting worse.
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Answered in 16 hours by:
1/10/2018
Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 12,245
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
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Hi. I'm Dr. Rick and I have two decades of ophthalmology and retina surgery experience. I'm online and happy to answer your question today.

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Do wer contacts?

Have you ever had any eye surgery?

Do you have any other medical problems or take any medications?

This is not an answer, but an Information Request. I need this information to answer your question. Please reply, so I can answer your question. I look forward to helping you.

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Customer reply replied 7 months ago
1) No, I do not or nor ever have worn contact lens
2) I had cataract surgery with IOLs both eyes about 30 years ago
3) I take 50 mg Losartan and 5 mg Norvasc for hypertension, once a day, may eventually discontinue
4) I am now tapering Mirtazapine, taking 7.5 mg at bedtime, expect to be off next week Started on it 5 nights ago. Note: In Nov 1, 2017, I suddenly developed serious back & leg pain, which led to surgery in Nov 20, involving spinal fusion, and during that time I was prescribed Norco, Percocet, Prednisone for pain and 15 mg / night Temazepam for sleep. I ended up having to see an addiction specialist to get me off the Temazepam, which is why I'm taking mirtazapine as the final treatment before I'm off all medications associated with that episode. 400 mg to 100 mg dosages of Gapapentin and 16.2 to 32.4 dosages of Phenobarbital were prescribed as part of this withdrawal treatment. I have not taken any pain medications for some weeks now.
5) I am in otherwise in reasonably good health, do not have diabetes, do not smoke, drink moderately, blood panel is normal, weight is 175, height is 5' 8", and I keep fairly active walking about 5 to 8 miles a week.
6) It is very likely I've had previous "episodes" of Dry Eye without realizing that I had the condition, but only recently was I actually diagnosed as having Dry Eye by an ophthalmologist, in spite of having been checked by ophthalmologists before. The last time I had an episode as bad as I am having now was about 3 or 4 years ago, which lasted about 3 or 4 months before it cleared up on its own.
7) I am currently meeting with my ophthalmologist regularly about this condition, but I am now pushing for more diagnostics to get a better idea of where I stand and what can be done about it.

Thank you for that additional information.

Here is something you can try at home and a discussion of what your ophthalmologist can do for your dry eyes. Ignore the discussion about allergies in the text as that does not seem to apply to you:

It sounds like you are suffering from an anterior segment/tear film issue. Many times, for all sorts of reasons, the anterior surface of the eye starts to have difficulties. What can cause this? Well, there are a number of conditions but the most common are dry eyes, allergies and blepharitis....many times all three conditions act together to make you miserable. In order to solve your problem you need to address all of these issues at the same time.

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 and the use of a medication called restasis to improve your 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. If this does not give relief then your eyelid opening can be made smaller with surgery (lateral Tarsorrhaphy).

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 is 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.

I understand that this treatment seems a bit "too low tech" to be of value, but after 2 decades of clinical practice, I can assure you (even from personal experience :) that it does, indeed, work.

Does this make sense to you?

Don't forget to mash the positive feedback button for me...the one labeled "excellent" is the most fun to push by far ;)

It's safe for you to press the positive feedback button now if you so desire. And, never fear, even after you press that button I don't go up in a puff of smoke -- I'll still be right here to continue helping you, but, as I do work for tips, I want to make sure you are happy before rating me.

Dr. Rick MD FACS

Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 12,245
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
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Customer reply replied 7 months ago
I actually have an appointment tomorrow morning with another ophthalmologist in the same office as my regular doctor, who will have a closer examination of my meibomian glands and then give me a little better picture of why I am suffering from this condition, and what she can do about it. She has been recommended by the office as the go-to ophthalmologist for Dry Eye, so it will be interesting to compare her observations and recommendations with yours, given that you haven't had the chance to examine me in person.It is encouraging to hear that there could be some "low-tech" remedies that could help reverse the severity of the symptoms of Dry Eye. I just feel like I might have had these kinds of issues for many years, and yet so far nobody has taken the time to do anything about "clearing out old gunk". It seems to me that we should start with that. Nobody's even told me to try to "lid scrubs", or how to do them, which is why it is excellent timing that you have just now told me, just before I'm about to have a discussion about this with the ophthalmologist tomorrow.
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