dry eyes - ?next step

[BasketzatDawn]

I have various autoimmune conditions. Dry eyes have been a feature of my life for a while now - I use lacrilube at night (very diligently, and I do notice the difference on the few occasions I fall asleep too soon or forget); and hypromellose eye drops in the daytime. In the last month or so it's got worse. I've gone frm using eyedrops a couple of times per day to needing them hourly. Even worse in last few days.

So, is there a next step in treatment? And should I speak to GP?

The only thing that's changed is that I've been on oral steroids most of this year - to begin with eyes were better, and allergies and hayfever, still better (I'm hardly needing antihistamines this summer which is great). I'm not due an eye test either, but will need to get checked later in year, I think, due to steroids. As far as I know risk with steroids for eyes is really glaucoma and cataracts, hence needing annual check. Maybe dry eyes thing just a separate wotsit.

I have dry eyes caused by meibomial gland disorder. This is where the oil-producing glands are not functioning properly. My optician diagnosed it (she put some drops in my eyes to do it) although I'm sure a GP could do the same. My optician said it is more common in women over 40 than in other groups (a description which fits me, don't know about you obv!). The optician said to use hot compresses on my eyes, which does the trick. Worth looking into?

Useful link here: www.patient.co.uk/health/Blepharitis.htm. (you need to scroll down a bit to find stuff about meibomial glands).

I am sure there could be another reason so even if it's not that it's worth seeing a GP or optician I think.

BTW I find Optrex dry eyes spray helps me, but most of the time I just need to do the hot compresses. I've not found any other drops that help particularly.

HTH.

Sorry, should have said I don't know about the steroid use and autoimmune aspect.

Hope you get it sorted, I know how uncomfortable it can be!

Interesting link, thanks. My eyes can be 'gunky' on wakening. A newish thing too. Yes. I should see GP, I know. . I am wrong side of 40 too. Oh well.

his dog, not this dog ....

I realised that my eyes hadn't been gunky at all when I first started doing the compresses. Once I'd started, all of a sudden they were gunky again, but the gunk is thicker and stickier than it used to be, IYSWIM. Does that sound like it?

For the hot compresses, I use a plastic tub and a flannel (a thin one is best). I boil the kettle and pour some of the boiled water over the flannel in the tub, let it cool down a bit and then apply the flannel to my eyes (folded into a pad). Top up as required from kettle (re-boil if necessary). The water has to be as hot as you can bear. I do it for a few mins every morning. At first I did it morning and eve to speed up improvement, but now once a day seems to be sufficient for maintenance. I apply a bit of eye gel to moisturise the skin afterwards because it usually feels a bit tight. You could give it a try maybe to see if it helps.

If you ask your GP for a referral to an ophthalmologist, they may be able to insert punctal plugs; these stop the tears from draining as quickly. If the punctal plugs are successful and the dryness unlikely to improve they can cauterise the openings of the drainage channels for a more permanent solution. The plugs are effective though, and not too unpleasant to have inserted!

I have dry eyes, and I wear a dry eye type contact lens. the relief when I put them in is great and if I wearmy I have to use the drops.

not suitable for all and I use a specialist contact lens practice-high street big brands wouldn't touch me with a barge pole but it's great for me.

the option tells me there is surgery available to plug tarducts deceased how fast the tears clear from your eyes but I'm a way off considering that!

I agree with Burnthisdiscodown...I developed dry eye syndrome after laser eye surgery. Struggled with lacrilube at night and eye drops during the day like you.
Then had punctual plugs inserted - very quick and painless. My eyes improved beyond recognition over a few days. I can't recommend it enough! That was over 18 months ago, and I've not had any problems since. The relief was incredible but I really remember how awful dry eyes were.

Sorry - punctal, not punctual!

OP there is a condition called Sjögren's syndrome. It's commonly associated with rheumatoid arthritis. It causes dry eyes and often mouth too. It tends to affect post menopausal women, but not exclusively. It can be tested for, I think you'd need a referral to a rheumatologist.

Have you tried going back on the antihistamines for hay fever to see if the dry eyes are helped? Gunky eyes in the morning seems like hay fever to me.

If the condition has worsened - I would go for an eye exam before you're due. If you're entitled to an NHS eye exam, they can see you before your due date if you're having problems. A viral conjunctivitis (for example) can make your eyes very dry, so its worth getting it checked.

Its a bit too soon for plugs (although they do work really well), there are lots of types of ocular lubricants that have a longer acting time that hypromellose for example systane.

I've also had tear ducts blocked and it helped a lot. Didn't hurt a bit and only took a few minutes.
Would recommend it.

Antihistamines can cause dry eyes (it's not just the excess mucous in your nose that they dry up...), so I would not advocate LongGoneBeforeDaylight's suggestion.

my money's on the steriods causing it .

but I'm afraid I dont know what the cure is .

rabbit stew whoops

Wow, I go out for the day and get all those replies, possibly the most answers I've had ever to any MN question . Thanks for all replies. Lots to consider. I am seeing specialist tomorrow (GI - I have AI liver disease and will mention eyes to him, as it is all linked).

I am pretty sure I don't have RA, bonzo. I do have other conditions that affect eyes and cause joint pain, but no way is pain enough to be RA, glad to say. I think there is so much overlap with AI stuff. One of the liver things I have (I have a rare overlap of features of more than one condition) causes eye dryness - never formally told it's Sroegren's - or sicca which is easier to spell! - but it seems to be that or related.

Really pleased another eye product can be prescribed - all my googling and I never found that. Ha, ha! Systane here I come! I will need to speak to the GP - but I need to get tomorrow over with (I am hugely nervous as last apt wasn't great and my bloods haven't responded brilliantly to steroids, and I'm having lots of side effects but think he'll want to increase again. wah, wah, wah!!)

Due to liver disease, I am quite cautious about what I swallow, and do want o keep tablets to a minimum. I do have nasal spray for hayfever though, should I need it. I do find heat and steam help the eyes, so that fits with compress idea - eg if I have bath the eyes feel better, for a bit. Recently I had sinus pain and was using hot flannels, and eyes were better incidentally. So deffo something in that idea.

Now time for bath and bed - and to write my list for tomorrow's appt. The doc man's heart will sink - he seems to not like questions ..... I can't really manage two busy consecutive days.

Thanks again, ladies.

There are tonnes of different daytime dry eye drops to work your way through until you find one that works. Always use preservative free ones, though, unless you want to develop an allergy to the preservative! Despite what the instructions say, you can use a vial more than once if you put the top back on (or so the consultant told me...), despite the lack of preservative. I keep mine going all day, then throw away at bedtime.

Despite being preservative free, however, I reacted to Systane, which is a shame, because it's a good level of thickness without feeling uncomfortable (until the allergic reaction makes your eyes go red and uncomfortable...)... I'm better with carmellose sodium (active ingredient in Celluvisc and Carmeleze). 0.5% isn't thick enough for moderately dry eyes (but 1% Celluvisc is very gloopy, so I used to water it down with a drop of 0.5%!!!.... 1% carmeleze is far less gloopy and feels very different in the eye, so hard to believe it contains the same active ingredient). You can even experiment with how you put the drops in your eyes, so as to ensure good coverage across the whole area...

Once you've got it under control, the problem tends to abate considerably - I often don't need drops at all any more, except on particular days in my hormonal cycle, when I'll use them 2-3 times a day!

ps definitely keep your eyelids clean and try the lid massage with hot compresses, as the main glands for lubricating your eyes are hidden away in there, so if they get blocked by all the ointments and things you are putting in your eyes, the natural lubrication won't be working effectively.

I find Hylo-tear drops very good. Also Systane.

I have secondary sjogren's (I have RA) and also use Hylo-Tear for daytime and Hylo-Forte (stronger) for nights or when my eyes are really incredibly unbearably dry during the day.

I'm struggling with dry eyes too. Those plug things seem a great idea!
I'd also heard the optrex eye mist stuff you spray on closed eyes is good as it helps prevent tears evaporating.
Anyone have experience of that?
I just currently use a contact lens wetting solution. my eyes are better with lenses in.

Op, I hesitate to even suggest this, but have you considered removing grains (all of them!), but especially gluten containing ones from your diet for a couple of months to see what happens?
Obviously this is not going to work for everyone, but many people get at least partial recovery from autoimmune conditions on a grain free diet (so require fewer drugs), and many others get a full resolution of symptoms as long as they stay grain/gluten free.

I am always very aware when Have eaten something I shouldn't (usually but not always, by accident). I get fairly rapid joint flares and typically very dry eyes/ mouth for several days (I can wake in awful pain with eyelid seemingly ripping off my eyeball as they stick together).
I am in my 40's and seem to have followed the "typical" trajectory of many years of increasing, probably autoimmune related health issues, followed by developing much worse (diagnosed) issues as I reached my 40's.... But now, I am healthy and not in pain (I had constant joint, bone and muscle pain, migraine, digestive problems, blah, blah, etc).

The funny thing is, I actually cut grains from my diet for other reasons, and was blown away by the sudden resolution of my illnesses, provided I stay grain free I am absolutely fine.

I will repeat again, obviously this won't work for everyone, but there is a lot of research about grains (especially gluten containing ones), and the development of autoimmune conditions (diabetes, thyroid, arthritis... A very long list of other things). The only way to find out is to exclude grains for a couple of months and then reintroduce them one at a time, and see what happens!

If you have no grain sensitivity/allergy /intolerance, then it won't make any difference to your symptoms but if you do, you can expect to see symptoms reducing within days. You may also get a worse reaction when you try to reintroduce grains (for me, significant stomach pains within 15-20mins of a mouthful of gluten containing food).

Exclusion diet will only work if you properly exclude grains - and it's not easy unless you cook everything yourself. I discovered my grain intolerances (I had long suspected tho!), doing the Paleo 30 day challenge (it's palaeolithic food so no grains at all!). If you are interested in looking into this further, you might want to have a look at Robb wolf 's paleo diet blog, and marks daily apple (primal blueprint), blog, or dietdoctor blog (Swedish lchf diet). All the info is free, although there are books if you want to buy them.

Apologies If you have already tried dietary therapies with no success