Hi Wade,
Undoubtedly the abrasion is contributing to your problem, but I think what is exacerbating the situation is probably LASIK induced dry eye.
During the night when your eyes are closed, the outermost cells on the cornea (epithelium) are nicely hydrated. During the day, these cells become dried out if there is not proper tear function. A known problem with LASIK is short-term induced dry eye.
Your doctor can measure both tear quantity and tear quality to help determine if you have dry eyes. What you can do now is purchase some preservative-free eye drops (TheraTears is one brand) and use them a few times during the day and see if you have improvement in your vision.
Keeping your eyes moist will promote healing, and that is important with an abrasion.
Dry eye symptoms can cause discomfort, vision fluctuations, slow healing, exacerbate astigmatism, damage epithelium, and cause poor vision quality. The amount that dry eye symptoms affect an individual depends on many factors. For the vast majority of refractive surgery recipients, the degree of dry eye symptoms is not significant enough to cause difficulties. Even those who do have some trouble most often find the dry eye symptoms resolve within the normal six-month healing period.
Exactly why LASIK induces dry eye is not totally understood. There is no doubt that LASIK induced dry eye is caused by a multitude of events. If the right combination of these events occurs, you have dry eye symptoms. If one component does not occur, you do not have dry eye symptoms. Generally, it is thought that LASIK induced dry eye is caused by the nerves in the cornea being severed when the LASIK flap is created, when the excimer laser removes corneal tissue, and/or by the change in shape of the cornea.
The disruption of the cornea nerves causes a decreased sensitivity to the cornea and interrupts the flow of information to the entire tearing system. The lack of sensitivity may cause a patient to blink less. The disruption of the normal flow of information may cause the system to not know that more tears are needed or that specific components of the tears are needed. It is also possible that the disruption of the corneal nerves will provide the sensation of dry eyes, when in-fact the eyes are appropriately wet.
Although the corneal nerves regenerate in a relatively short period of time, while they heal there can be dry eye symptoms. Most LASIK induced dry eye is resolved within the normal six-month healing period.
To properly maintain or resolve refractive surgery induced dry eye problems, it must first be determined exactly what is contributing to the dry eye. It is not as simple as not making enough tears. Dry eye symptoms are cause by one or more of three occurrences. Reduced tear production. Increased tear drainage. Distressed quality of tears. Each requires a very different response and responding to the wrong cause can exacerbate the true cause of dry eye symptoms.
There are actually three layers of tears. The outermost is the lipid, center is the aqueous, and at the base of the tears is the mucin. Each of these are produced in separate glands near the eye. These three combine to provide the eye, particularly the cornea, with nutrients and lubrication.
The mucin makes the tear viscous and allows it to spread evenly over the whole eye. If there isn't enough mucin, then the tear doesn't smooth out and cover the cornea. The mucin acts like a "glue" and helps hold the tears to the eye. The aqueous is the thickest layer in the tear and is the water that protects and lubricates. The lipid is the outermost layer and is essentially oil. The oil helps keep the aqueous from evaporating too quickly.
The other important component to healthy tears are the drains called punctum. These are tiny holes at the upper and lower edges of your eyelids that allow tears to flow out while new tears are developed and delivered to the eye. There are two upper and two lower punctum per eye.
Here are some ideas for treatment to manage dry eye problems. These techniques have helped patients with LASIK induced dry eye while they healed after surgery. These techniques can be used by anyone experiencing dry eye symptoms, not just those who have LASIK induced dry eye symptoms. All techniques should be verified with an eye doctor before utilization.
Examination - Your doctor should be evaluating the health of your eyes. Dry eyes slow healing and can cause other problems. The doctor needs to be sure some other health problem is not contributing to your dry eyes.
Check Medications - Many medications have dry eye inducing properties. Antihistamines, allergy medicine, hormone replacement therapy, other over-the-counter and prescription medications can exacerbate dry eye symptoms. Tell your doctor any and all medications you are taking, even if you think they have nothing to do with your eyes. The darnedest things can contribute to dry eyes. Check with your doctor if an alternative that is less likely to affect dry eyes is available.
Get Tested - There are two primary tests to determine what is causing the dry eye symptoms. The Shirmer test is to determine tear quantity. This is the process of putting tiny strips of paper in your lower eyelid and determining how far out the tears soak the paper in a specific amount of time. The other is called a Tear Break-Up Test (TBUT). TBUT is the application of a staining solution that shows where on the cornea and when the tears break apart.
Drink Water - Drinking plenty of water and restorative fluids may seem obvious, but if you are dehydrated, your eyes will be dehydrated too.
Avoid Dry Areas - Air conditioning, heating, extreme cold and extreme hot weather will dehumidify the air. If possible, avoid these areas. Air movement will also dry tears. Avoid having a fan directly on your face.
Humidify - Wherever possible add a humidifier. A humidifier in your home or at your workplace can help dramatically. Add a humidifier to your bedroom for nighttime and, if possible, around your work area.
If you don't have a humidifier, just bring a pot of water on the stove to a slow boil. You can even add potpourri or soup bullion to make the house smell nice.
Artificial Tears - Be sure any artificial tears you use are free of preservatives. Preservatives can actually cause dryness. TheraTears, HypoTears, Bion Tears, and GenTeal are some brands of preservative-free eye drops. You can always tell they are preservative free because they cost quite a bit more than the preserved drops. Use these drops whenever you think you need them. If you do not notice an improvement, make an eye drop schedule. Remember, your corneas may not be able to tell you they need more tears. Start with four times a day and adjust accordingly. Generally, you cannot use too many tears.
Flax Seed Oil - This is a nutritional supplement that you can purchase at most health food and vitamin stores. Taking flax seed oil each day has been reported to help with dry eye by increasing the quality and quantity of lipid tear layer. The flax seed oil liquid seems to get better results than the tablets, but it tastes awful. Mix it with fruit juice or even yogurt - something with a strong flavor. Dosage is around two tablespoons a day, or as recommend by the manufacturer.
Lubricating Gels - Along with the preservative-free eye drops, you can get gels to use at night. A couple of brands are MoistureEyes and Refresh PM. These are especially helpful for those who do not close their eyes completely at night.
Punctal Plugs - an eye doctor can provide these. They are tiny plugs that stop or slow the flow of tears away from your eyes. Punctal plugs come in many styles and sizes. A comfortable fit should be available for all. Initially you may be provided with temporary punctal plugs. After about 10 days, they dissolve. If you receive relief from dry eye symptoms during those 10 days, then semi-permanent plugs may be inserted. If you do not find relief, then the temporary plugs are already gone. It is also possible to have these tear drainage ducts permanently occluded with cauterization, but that is rarely recommended. The semi-permanent plugs are normally comfortable and successful, and LASIK-induced dry eye normally eventually resolves.
Protective Lenses - In general, protect your eyes from windy weather or extreme cold/hot. If you are one of those who sleeps with eyes partly open, using a lubricating gel and those small swimming goggles may be appropriate.
Blepharitis Treatment - Scrubbing under the eye lids with warm water and baby shampoo, plus warm compresses that are the normal treatments for blepharitis often are helpful. The warmth makes the oil in the tears flow better and the scrubs keep the openings open.
Antibiotics - You need to talk to your doctor about this, but some antibiotics may be helpful. A new application of this treatment is in the drug Restasis.
Steroids - Some doctors try to treat dry eyes with topical steroids. While this may be helpful, long-term use of steroids can result in other problems. Consult your doctor.
Second Opinion - If you think your doctor is not knowledgeable enough to help you with your problem, get a second opinion. At the very least, you will know if you are receiving the care and treatment you should.
Glenn Hagele
Council for Refractive Surgery Quality Assurance
http://www.usaeyes.org
I am not a doctor.
