I can't wear contacts because I have dry eye.

Is someone with dry eyes a candidate for lasik?

First - if you have dry eyes now - you should see your own doctor and start treatment to see how the dry eyes respond. Restasis, which is the only FDA approved medication for dry eye, maybe a useful option (discuss this with your doctor).
Studies have shown that patients with preoperative dry eyes who were pretreated with Restasis were less likely to have dry eye symptoms after LASIK. But still - you need to work first to get your dry eyes under control before considering surgery.
Another consideration - Epi-LASIK or surface ablation causes less dry eye than LASIK - and that may be a better option.

Best of luck

Bill Trattler, MD
Miami, FL

Dr. Trattler, I would like your opinion on this. Given the fact that Restasis is so new and a response to it may take weeks to months, does anybody know what the treatment duration is going to be? In other words, does a course of treatment result in a permanent effect such that it can be discontinued, or will the Restasis need to be taken indefinitely?

I have been asked the question, but I had to admit that I did not know the answer.

DrG

Greg,
It all depends on the severity of the dry eye. Remember dry eye is really an inflammatory disease - with an elevation of inflammatory cytokines, reduction in goblet cells, and a reduction in the quality of the tears. Restasis works to improve the tear film by reducing the inflammation, increasing the goblet cells, and improving the quality of vision.
For patients with mild to moderate dry eye - restasis can restore the balance of the tear film - and then restasis can be stopped. In patients with more severe dry eye - the restasis is only going to control the inflammation - and once the restasis is stopped - the dry eye will worsen (similar to high blood pressure - high blood pressure medications control blood pressure only when they are used).
Obviously - we can use additional treatments to help. Punctal plugs, preservative free tears, low dose steroids, warm compresses, etc.

I hope this helps

Bill Trattler, MD
Miami, FL

>Greg, It all depends on
>the severity of the dry eye.
> Remember dry eye is really
>an inflammatory disease - with an
>elevation of inflammatory cytokines, reduction in
>goblet cells, and a reduction in
>the quality of the tears.
>Restasis works to improve the tear
>film by reducing the inflammation, increasing
>the goblet cells, and improving the
>quality of vision. For
>patients with mild to moderate dry
>eye - restasis can restore the
>balance of the tear film -
>and then restasis can be stopped.
>In patients with more severe dry
>eye - the restasis is only
>going to control the inflammation -
>and once the restasis is stopped
>- the dry eye will worsen
>(similar to high blood pressure -
>high blood pressure medications control blood
>pressure only when they are used).
> Obviously - we can
>use additional treatments to help.
>Punctal plugs, preservative free tears, low
>dose steroids, warm compresses, etc.

>I hope this helps

>Bill Trattler, MDMiami, FL

I have severe Dry Eye and have been on Restasis for about two weeks now. I have noticed a gradual increase in the burning and tearing that I experience with each dose. Within two days of starting the drug, I started experiencing burning with each dose. The burning has gotten worse and a few days ago excessive tearing started to accompany the burning. This lasts about an hour or so. It does not matter if I use drops 15 minutes before and after dosing with the Restasis, or if I used the Restasis chilled. The burning and tearing I describe is an increase over the usual amount that I experience at other times of the day. I have not noticed any change in my symptoms since starting Restasis. Is this a sign of sensitivity to the medication?

Well, I guess I will answer my own question. I have developed a sensitivity to Restasis and have been taken off of it. It did help my photophobia, the price paid for that was too great.

I cant wear contacts either because they really dry my eyes out then they irritate. Trattler has mentioned LASEK is more forgiving on dry eyes.

James,

I had lasik three months ago and could not wear contacts because of my severe dry problem. My doctor had me use liquidgel eyes drops and warm compresses to help me adjust after the surgery. I still used the other prescribed eye drops you need to use immeadiatly after the procedure. At first I was frustrated that everything looked like I had vaseline smeared in my eyes and the constant feeling of "dirt" in my eyes. But I had patience and now my eyes are doing GREAT. I still use eye drops to keep my eyes moist and warm compresses, but I am feeling more confident. You may not be as sucessful as I was and your doctor may not do the same procedure as everyone eyes are different, but I just wanted to share my story as an average person who hated her glasses and couldn't wear contacts due to the dry eyes. Talk to your doctor about the options that is available and take your time. There are lots of tests to make sure you are a good canadite for the surgery. I found being informed before and after the surgery has helped my progress. Good Luck. Patience and taking good care of your eyes is the key to making the best and good best results. And don't be afraid to ask lots of questions.

Bridget

i had lasik 2 and half months ago because i could not wer contacts for long time ..... i must tell u the fact lasik worsen dry eye, now am feeling that dry ness is redusing a bit but cant predict the nature of dry eye it mite come back again ...

prk is more forgiving, so is IOLs. lasik often makes dry eyes worse