I am from the UK. I had surgery done in June 2004 and after some initial dryness of a couple months my eyes got better and felt great for about 6 months. But then they started to feel dry. It was the winter and I started working in an overheated dry office so i think thats what started it off. I think my LASIKed eyes just couldn't cope with working in a dry atmosphere. I was told to use visotears which i did for two months and probably used over 6 times a day at work. I then started experiencing severe dry eye symptoms and found out i shouldn't have been using this preserved eye drop. I had a schmir test done and both of my eyes were 0. I got my right eye plugged which was causing the most discomfort (grit in eye feeling),used preservative free drops and also was told I had blepharitus and so did lid scrubs with baby shampoo. 6 months later my right eye got better and I now have a schmir result of 3 in that eye. Unfortunately as my right eye got better my left seemed to get worse with a burning sensation in the eye a lot of the time and constant dryness when at work. My schmir result in that eye is now 2. I tried getting it plugged but it made no difference, even a bit worse. As eye drops only provide relief for 5 minutes I have come to the conclusion the eye is dry because of a poor lipid layer- i feel as though i have evaporative dry eye. I am now doing warm compresses and lid scrubs in the hope it will get better like my right eye did. I have noticed I get a lot of blocked meiobian glands in this eye and also that it is these that give me that gritty feeling! especially when I have them under the upper eyelid where I have to pull up my eyelashes to see them. So far I think the burning sensation is a little better for doing the warm compresses. I hope by writing this it will give some people with dry eye problems food for thought and that they might realise why they developed dry eye some time after surgery like me. I don't feel there is enough information about LASIK induced dry eye and so have given it a lot of thought and come up with different theories. I cannot understand why when I have such a low schmir result of 2 and 3 why I am not experiencing more discomfort than some people on here with schmir results of 8 who still have very bad dry eye symptoms. I admit I do have it bad enough that I can not be in a dry place for long periods of time but when i am at home I can get through some days without using any eye drops and have no trouble sleeping at night. I think maybe the oil layer is more important than the water layer. My theorey is LASIK directly lowers the water layer (cut nerves linked to lacrimal glands) which is very much needed to keep the meiobian glands functioning as they should (i.e. keeping them clean and unblocked!). So thats why dry eye may take months to develop after surgery as the blepharitus (i.e. disease caused by bacteria that blocks meiobian glands) takes time to take over. I guess regular use of eye drops should keep meiobian glands clean, but you would have to keep using them religiously. Also I think i probably can't feel how dry my eyes really are as have had nerves cut so didn't use eye drops enough in order to keep eyes healthy! I can not get hold of Restatis unfortunately as I am in the UK and it hasn't been okayed over here yet. Has anyone tried using the new drops Endura which contains the oil layer in it. I am hoping to get hold of this and try it. I will also keep up with the lid scrubs to keep meiobian glands functioning properly and advice anyone with dry eyes to give it a go. I would like to hear if what I have written makes sense or if anyone has had similar experience. Also I would like to hear from anyone who has a schmir result as low as mine.

Hi Ann,

I'm sorry that you are having dry eye problems. What you wrote makes sense to me, but I am not a doctor. Just another post-lasik dry eye patient. I try to figure things out just like you since this confuses the heck out of me as well! Initially my schirmers results were around 4mm - 6mm...last week when I had them done they were only 2mm. I was having an extra dry week, so that might explain why they were so low. My comfort level does fluctuate around, but I think that you are right about the oil layer being very important. I'm 7 months post-op now, and initially, my TBUT scores were very low (around 2 or 3 seconds). They have improved significantly since then. Although I have such a low schirmers, the doctors tell me that I do not have any dry spots on my cornea now, and I did in the past. So, I do not understand how an eye with so few tears, can actually keep a moist cornea? I think this is where the oil layer comes into play. My doctors have told me that my blepharitis (only developed this since surgery - or atleast only became symptomatic since surgery) looks much better now than it did before, so I think the fact that I have my oil glands flowing better now, makes the little tears that I do have, better tears. I am still uncomfortable alot, and even in pain at times, but there are other days, where as long as I'm not in a dry environment, I get by OK with very few tears. Although, I wouldn't say that my comfort level has improved greatly over the months, I think that the surface of my eye looks alot better to the doctors than it did months ago. I did warm compresses and eyelid scrubs to get the blepharitis under control. I also take fish oil, flax seed oil, and HydroEye supplements, and I think they have helped as well. You may want to try some of these supplements if you currently are not.

I should mention that I have upper and lower plugs in each eye, so I think that helps with the fact that I have so few tears. I do not have ANY overflow with all 4 plugs. Anyway, I just wanted to respond since I had a low schirmers as well. I hope that a doctor responds to you, and that you find a solution to your problems. I will be interested to see any more responses since your theory seems reasonable to me. Good luck!

Michelle

Thankyou very much Michelle for your reply. I am sorry too that you have had problems with your eyes. It doesn't matter that your not a doctor because I would prefer to hear from someone who has experienced similar problems.
When you say initially your Schmir was 4 and 6 mm, was that soon after your LASIK surgery or before it? (i was never given a schmir test before surgery so i don't know mine). If it was after then maybe your Schmir result did get worse in time because of the blepharitus. I too was only diagnosed with this after LASIK. My TBUT measured by the eye hospital is 3 and 4 seconds although a surgeon at my clinic got 6 seconds and 4 seconds (they seem to change alot). Also my clinic told me, like you, that the coverage of my tears were quite good with few dry spots (i guess before the tear breakup).
I've started eating more healthy- lots of fish! and taking Omega 3 tablets(also with a digestive enzyme as don't think i digest fats all that well). Thanks for the suggestion, i might try Hydroeye if i see no improvement. Do you still need to do warm compresses and lid scrubs to keep the blepharitus at bay?? I have found in the last week that this has been helping with my left eye that was burning of an evening and the tear film even looks thicker- although the moisture levels in the air is up at the moment here in England so that makes a big difference to me. I seem to manage ok outside of dry places and as I happen work in a hot dry office I am off work at the moment. Do you work in an office, at a computer? If so how do you cope? Have you tried Endura.
Hope to hear from you again or anyone else with similar symptoms.

Hi Ann,

They did not do dry eye tests on me before surgery, so I have no idea what my schirmers scores were before hand. For months after my surgery they told me that the problem was my tear quality, and not tear quanity, so they never did a schirmers. The first time they did it was around 4 or 5 months post-op and that is when it was 4mm and 6mm. Next time 5mm and 5mm. Then 2mm and 2mm. Then last week it was 3mm and 4mm. Based on this, I do think that they can fluctuate wildly, so I try not to get too upset when they are down. I did not realize that the blepharitis could reduce tear production too, but maybe that is part of the problem. My dryness definitely gotten worse now that it is winter, so I always thought that had alot to do with it.

About the blepharitis...I still do the warm compresses and eye lid scrubs 2x a day. I don't do the scrubs as faithfully as the compresses though because sometimes my eyelids are very sore, and I find even the most gentle scrub will irritate them. My docs do say that my oil glands look better, but I'm not planning on quitting any of my treatments I"m doing until my eyes are back to 100%. At two months post-op my TBUT was 2-3 seconds. I see two docs, the lasik ones always tell me it is over 10 now, and the other doc I see always says it is around 6 or so...they must count at different speeds! Also, just like the schirmers, I think these scores can fluctuate too. Anyway, it has improved, and I can feel the difference. I'm glad to hear that the compresses seem to be helping you. Stick with it! I think sometimes it can take a while to get it under control depending on the severity. Mine wasn't severe to begin with which is why I think I got it under control pretty quickly. Another thing I try to do sometime is an eyelid massage. It is supposed to help get the oils flowing after you do the hot compress. I don't really have a perfect technique down yet as I'm just trying different techniques I've read online, but that might be something that works for you too.

I do work at a computer all day, and sometimes it is rough. I try to blink more often, take frequent breaks to rest my eyes, and I have a humidifier running in my cubicle. I think all these things combined have helped a bit. I have tried the Refresh Endura drops, but right now I'm using Systane or Bion Tears. I think these are more comfortable than the Endura.

It is good that you are eating healther..I am also trying hard to do that as well. Also, drink lots of water! It is good to keep your body hydrated for tear production purposes.

What do your doctors tell you about all this? It looks like you had your surgery one year before mine. Do they still think your eyes will get back to normal? Do they still tell you that your corneal nerves are still healing and all? I have talked to a few people who saw significant improvements in their second year after surgery, so hopefully that will be the case for you.

-Michelle

I am sorry to hear you were not given a dry eye test before your surgery. I think that that was negligent. I think a Schmir test should be standard before this surgery and results hsould be recorded for the patients knowledge and for future research into how LASIK affects the moisture of the eye. I am complaining to my clinic, I think they gave me a TBUT test but I do not think this is sufficent. This is what I think (some of this I have already told you but it may help to hear it again, i strongly feel this is correct):-

A tear break up time test is not very accurate because it can be difficult not to blink which would affect results. Also TBUT is very dependant upon a good lipid layer (the oil layer) in the tear film which prevents evaporation of the fluid part of the tear film. Since developing dry eyes I have done a lot of research and discovered in preventing dry eyes the lipid layer is considered to be the most important part of the tear film, and correct functioning of the lipid layer comes from a good water layer to keep the Meiobian glands (that produce the oils) in the eyelids clean. LASIK surgery directly cuts the nerves that stimulate the Lacrimal glands (that produces the water layer). Prior to surgery someone may have just enough water volume to keep these very important Meiobian glands functioning correctly, but if this aqueous layer is lowered (say from LASIK) they can then become dry and blocked up. This is what has happened to me and I have been told I now suffer with blepharitus (which I never had prior to surgery). Therefore I think a Schmir test is very important because it measures the tear volume that is directly affected by the LASIK surgery. Hence someone who had a borderline (below average) aqueous volume but good oil layer may not show up as having dry eyes with a Tear break Up Time test. A Schmir test shows quite clearly if someone has borderline volume of aqueous tears. I think it is crucial that this test is done, especially as dry eyes is the most common and can be the most devastating side affect of LASIK surgery.

Read this www.lasermyeye.org/forums/archive/index.php/t-413.html
It shows how corneal nerves return to normal after 2 years but then become worse after 3 years. This is the only research i have seen done for corneal nerver healing. The doctors at my eye hospital think my dry eye is permanent as it has been over a year. But what do they know, it seems very little is known about this surgery.

I think you have a very good chance of a good recovery as you have caught the dry eye early on and seeked help, well done. I got help for my right eye 10 months after surgery and it is better (4mm schmir)than my left which I didn't get plugged until 15 months after. I am hoping the continual blepharitus control is going to help. I have read that when the eye is dry and irritated that the lacrimal glands that produce the water layer actually stop producing tears. Hence that is how restatis is thought to work because it is an immune represent, so the tears start working again. My theorey is that the eye may do this because if there is no oily layer then having a watery layer will may the eye more sore by the evaporation process (think of chapped hands!).I can;t get hold of restatis but i am hoping if i can help the dryness with lid scrubs etc then the watery tear layer will increase. If this theory is true then i think it is a very important part of the recovery process and may explain why your schmir results have varied so much . I hope i am making sense to you.
Thank you so much for your reply and for your information. I think i will try Bion tears and systane as havn't found Endura to be that good either. Goodluck with your progress and please keep me posted on how you are doing and ask me any questions. i wish you all the best.
Caroline

Ann,
Great theories - but I have to disagree.

1. Tear Break up time is very consistent if done under proper testing conditions. I have performed studies on new dry eye medications, and in these studies we always measure tear break up time. We use a stop watch and measure tear break up times at least 3 times - because the times are often within less than a second. So a typical score might be: 3.24 seconds, 3.61 seconds, 3.37 seconds. Then we average the numbers. But clearly in my experience the tear break up times are consistent - and useful measures of the degree of dry eye.
Of course - tear break up time is low in all forms of dry eye - from Sjogren's syndrome (lack of tear production, or low water content of tears) to meobomian gland dysfunction. I was taught that tear break up time was only low with oil issues - but in actuality it is low with low aqueous volume of tears.
Finally - lack of aqueous tears has never bee shown to be the cause of meibomian gland dysfunction.
I hope this helps

Bill trattler, MD
Miami, FL

>Ann, Great theories - but I
>have to disagree.

>1. Tear Break up time is very
>consistent if done under proper testing
>conditions. I have performed studies on
>new dry eye medications, and in
>these studies we always measure tear
>break up time. We use
>a stop watch and measure tear
>break up times at least 3
>times - because the times are
>often within less than a second.
> So a typical score might
>be: 3.24 seconds, 3.61 seconds,
>3.37 seconds. Then we average the
>numbers. But clearly in my
>experience the tear break up times
>are consistent - and useful measures
>of the degree of dry eye.
> Of course - tear break
>up time is low in all
>forms of dry eye - from
>Sjogren's syndrome (lack of tear production,
>or low water content of tears)
>to meobomian gland dysfunction. I
>was taught that tear break up
>time was only low with oil
>issues - but in actuality it
>is low with low aqueous volume
>of tears. Finally -
>lack of aqueous tears has never
>bee shown to be the cause
>of meibomian gland dysfunction.
>I hope this helps

>Bill trattler, MDMiami, FL

Dr. Trattler,

Are you saying that a schirmers test is not necessary before lasik to determine if you have dry eye? In my situation, they were negligent either way because they did not do a TBUT or a schirmers. How can LasikPlus, one of the big lasik chains that does hundreds of thousand of surgeries, not properly screen their patients??! Anyway, back to my question....if a TBUT is a good indicator of dry eye, then how come for the last few months, everytime I go for a checkup at my lasik place, they tell me that my TBUT is greater than 10 seconds, but then my schirmers is like a 2mm or 3mm. That does not make sense to me. From what you said in your last post, it sounds like my TBUT should also be low if my schirmers is low?? Is that correct?

Also, is the schirmers test prone to fluctuating around alot? Mine are usually between 2mm and 6mm, and I'm just wondering if it is normal for them to change like that. Thanks!

Michelle

Thankyou for your response. However nothing you have said makes me think any differently. I never said TBUT was inconsistent. I was saying you could have a good TBUT with a low Schmir test result or low water level if the water content was just enough to keep the Meiobian glands producing the oily layer. So a schmir would be better in my opinion as a measure of dry eye (BEFORE Lasik)as it is measuring the water content which is directly affected by LASIK and would show if someone was boardline. I think you can have a good TBUT with fairly borderline/ low levels of water layer. Such as in Michele's case. I am not wishing to be argumentative but I have done a lot of research and have personal experience and strongly believe that the Schmir test more accuately measures boardline cases of dry eye before undergoing LASIK than a TBUT.

I would just like to say Michele that I was told by my LASIK clinic that my TBUT was 16 seconds at 10 months when my Schmir result at that time was 0. Now they are saying it is 6 seconds. I believe if your schmir is only 2mm then this would not be enough to keep your oily layer healthy and that probably your TBUT is not as high as they say. I would seek an independant opinion as the eye hospital told me that my TBUT is only 3 seconds. However you did say you scrub your eyelids and use hot compresses so maybe this is helping keep them clean and working better. You can measure TBUT yourself by blinking twice, looking straight ahead and try not to blink. Time how long you can comfortably not blink before you feel any dry eye (however this is more accurate for someone who has not had LASIK as you may not be able to feel the dryness as you have less nerves. Therefore I find the clinical TBUT result at the eye hospital is lower for me than my own testing). Best Wishes. Caroline

Also I would just like to ask what would you consider a borderline value of TBUT?? i.e. a safe level for someone to have LASIK surgery. Because if it is say over 20 seconds or more ( I know anything less than 11 seconds is considered dry eye so borderline must be at least 15 seconds or more) then patients have to hold open their eyes for a very long time before a surgeon can see if they have borderline dry eye. I remeber my surgeon telling me to try not to blink which i found very hard to do. I think in the end he just gave up as I don't remeber him staring at my eyes all that long when doing the TBUT. I would really appreciate an answer to this question, as there must be a considered standard.

Ann,

I was also curious about the TBUT test. There are times when the doctor has to tell me to NOT blink because my eyes are uncomfortable and I want to close them. So, I have had doubts that they really are accurately doing the test. For example, once I counted myself and could not even keep my eye open for 10 seconds and they said my TBUT was greater than 10 seconds. Personally, I think they just like telling me what I want to hear and pretending there is not a problem. Ofcourse, they cannot lie on the schirmers test because the results are right there on the little strips of paper. It is all very frustrating. The doctor I am seeing for a second opinion usually tells me it is around 6 seconds.

The doctor does not seem to think that the blepharitis is caused by the lack of tears, but why is it that so many of us have problems with our oil glands afterward? In my case, they tell me the blepharitis is mild, I probably had it before lasik (another thing they should have caught and didn't), and it would not have bothered me if I did not have lasik. But it sounds like you and others I have talked to have very bad problems with their oil glands after surgery. There must be something about the lasik that causes it or causes it to become much worse. I have heard though about how it can take a long time to get the oil glands functioning properly once they are clogged, so just keep up with the lid hygiene and compresses, and hopefully you will see improvements. Thanks for sharing your information...I do find your ideas very interesting.

Michelle

I think you are right and that you laser clinic is not being truthfull with you or that they are not very well trained in doing a TBUT. My doctor counts 1000, 2000, 3000 for the seconds- why don't they use clock? 6 seconds sounds more likely for your TBUT. I am going down the clinical negligance route and complaining to my clinic. I think its all too easy for LASIK surgeons/ companies to not give (proper) dry eye tests before surgery because they don't want to lose our custom. Funny, also,how there is no official standard pre-surgery borderline dry eye test result whether it be a Schmir or TBUT when there are border limits for pupil size etc. I think they should give both Schmir and TBUT tests and any other that there are and if borderline on any result then major warnings to patient should be given. Also the dry eye tests prior to surgery should be recorded on patient's record. This should be standard policy for all LASER companies- its all too easy for them to wipe their hands of responsibilty and blame it on the surgeons. If surgeons and patients are aware of dry eye before and after surgery then with appropriate treatment like tear duct plugs/ restatis early on then better healing may occur. Personally this has majorly affected my life from losing one job in air conditioned office and now it seems am losing current job aswell. Its good you can humidify your work environment- i have tried that but i am not in a cubicle and in an open plan office. I think its going to be hard for me at my level of work to find somewhere i can work where i have my own office that is humidifable. I think i might have to half my salary and become a post lady or something! My doctor is willing to certify me as disabled as I can not be in another person's car without suffering pain (from the heating/ air con), also any public transport for same reason. Do you have dry sinuses as well? i find in dry rooms my nose really drys out and start to bleed. Apparently this is from dry eyes as well as no tears going down the tear ducts into nose as in normal people. I find it really painfull.

Regarding the oil glands problem it is well known LASIK reduces the aqueous (water) layer. This layer contains salt and many anitbodies that protect from infection etc and I think in normal eyes this helps keep the blepharitus at bay. My eye hopital doctor told me everybody has blepharitus to some degree so it makes sense to me why it gets out of control. Blepharitus normally affects older people because they naturally have reduced water layer in eyes. I don't like giving that much thought as dred to think how my eyes will age. Hopefully there will be better and more available drugs out there by time i get old. I forgot to say to you if your eyelids are sore from scrubs maybe try not using baby shampoo but just boiled filtered water instead which is what i do. Also i get some rice in a pair of tights and cook in microwave for 20 seconds ish and that worse really well as a warm compress and lasts 5 mins or more (don't use a wet flannel as tap water in eyes in not good). I will try and keep up this routine as seems to be working, although it may be because I've been signed off work for last month and have been out of my sahara desert like office.
Goodluck and keep me posted. Caroline

I personally perform Schirmer's tests on all patients prior to refractive surgery. I also look at the level of the tear film, and stain the cornea. As well, I examine the meibomian glands, and look for meibomian gland problems. Of course - patient history is critical - is someone coming for suregry because they have contact lens intolerance. Do they have dry eye sytmptoms? etc.
Studies have shown that patients identified with dry eye pre-surgery can have less dry eye symptoms post surgery if they are pretreaed with Restasis.
I personally feel that Schirmer's tests are very helpful in determining the degree of preop dry eye, but other doctors feel that Schirmer's tests are not reliable - and things like patient history are a better predictor of postop dry eye problems.
I hope this helps

Bill Trattler, MD
Miami, FL

Thank you for your reply. I think it sounds like you do thorough dry eye testing which is good and very important. My grivance is that I raised concerns with my surgeon in my consultation that my eyes might be too dry for the op because I could only wear contacts for a few hours a week because my eyes would get so dry. He just said "oh thats dry eyes with contact lenses" implying that it was something different to having dry eyes. I did not get a schmir test and think he only did a TBUT test and if so counting the seconds in his head. He angrily kept asking me to try not to blink, which i couldn't do, and then gave up i think. The doctor at my eye hospital says i most definatley would not have been a good candidate for LASIK because my eyes are now so severly dry. Do you think my surgeon has acted negligently?

I too got blepharitis after the surgery and never had it before.

There is no question in my mind that the surgery causes blepharitis - whether its caused because there is a lack of tears or because many people are super careful not to get water in the eyes, as per doctor instruction, that it causes the area to get dirty and become infected.

whatever the case may be its mad annoying but the surgery was still worth it.

what ive learned:

if lid scrubs and compresses alone are not doing the trick for blepharitis....

1) eat very healthy - a lot of green salads
2) avoid white bread, pasta, white flower and sugar
(yes all studies point to the fact that if you are super healthy, your immune system would have been able to fight the infection that caused blehparitis)
3) take a lot of vitamin C, cartenoid complex, fish oil and flaxseed oil
4) avoid salt
5) shower 3 times per day (this really helps)
6) drink a lot of water
7) try doxycycline and /or special bacitracin ointment for the night
8) try Genteal Gel for severe dry eye (it comes in a little tube and ive found that when i use it during the day like 2 times per day i dont need eye drops at all. Ive noticed however that after a while since the bottles been opened it causes the eye to sting
9) lastly, live in good weather if u can

Thank you for your tips, I am trying to eat more healthily now so hoping in time this will make a difference. I think my problem is more dry eyes than blepharitus. Aparently everybody has blepharitus to some degree and i think this is exasperated in those with dry eyes (from LASIK) because there are less anitbodies (kept in tears) to fight of bad bacteria. Anyway I am trying to be more healthy so my blood sugar levels are better and don't drop, I think this contributes to dry eye problems (hence why they ask you if you are diabetic before LASIK) and my ability to cope with the discomfort. I am not diabetic but do suffer with hypoglycemia. Its worth a try anyway. Goodluck to you.

I, too, ended up with blepharitis 2 months after LAISK surgery. I never had it before -- at least, not that I was aware of. My dry eye and blepharitis are extremely painful, they keep me from sleeping, and make it very difficult to work on the computer. To add insult to injury, I also had a very poor LASIK outcome.

My pre-op Schirmer's test was 4mm (far below normal), but my surgeon did not inform me of the results and proceeded with surgery anyway. Later, when I obtained my medical records and confronted him, he said that my low Schirmer's test was not a concern because "men usually don't have chronic dry eye problems." The only thing that I've read that even comes close to this remark indicates that women have more of a dry eye problem during menopause, but nothing I've read and no doctor that I've spoken with claims that men don't suffer chronic dry eye. My surgeon did not diagnose my blepharitis and kept telling me that everything was fine, despite my complaints of pain.

Eleven days after my last visit with the surgeon, I visited another ophthalmologist who immediately diagnosed me with blepharitis and poor tear film (too oily). He put me on doxycycline, Restasis, eye ointment, and eyelid scrubs. I find the eye ointment very tricky and uncomfortable to use. It's just too thick for me and seems to make sleeping even more difficult. I've switched to Genteal Gel, which has a little thinner consistency and feels cool when applied, which is soothing when one's eye is burning.

Not only did my surgeon act unconscionably by ignoring my Schirmer's test data (What's the point of performing the test if you're going to throw out the data?), but a second opinion told me that my pre-existing dry eye could very well have affected the accuracy of my wavescan results, which, at least, offers one possible explanation for my poor LASIK outcome and the large amounts of high-order aberrations that were surgically induced into my cornea by the so called "custom" LASIK procedure. Surgeons like mine seem to think nothing of destroying their patients' vision and lives as well. It's very sad and patients should be better protected.

I sympathise with you. I think you should sue your surgeon or LASIK company. 4mm is dry eye, not even borderline, its worse! Anything less than 6mm is considered dry eye. I have done extensive research and read almost everything there is on dry eye and you are right men have less dry eye problems in older age because of hormones (i.e. hormonal changes during menopause and pregnancy for women but not men). This does not mean men don't get dry eye. Of course they do. I am sorry to hear you also have vision problems. I am still short sighted in my dominant eye and have night vision problems with star bursting with car head lights which make driving uncomfortable and dangerous. The dry eye, which is worst in my short sighted eye, makes my vision blurry aswell. My surgeon told me he was going to make me slightly long sighted (0.5 dioctres)as my vision was still regressing and this would allow for a few more years regression. However he therefore managed to get my right eye 1 dioctre out of which he planned and also there is no record on my records that he planned to do +0.5 dictres. It maddens me the chances these surgeon's take with our quality of life! You never said how long ago you had the surgery? all i can say is with time you can learn to adjust. I have learned my condition is ok if I stay in moist and cool atmospheres which basically means no air conditioning and when in an office having a window open to keep it cool (below 21 C) and humidifying the air when it drops below 50% humidity. My Schmir is now 2mm but in doing the above I find my condition much much more tollerable. I have been lucky so far no pain at night (only very dry eye in the mornings). I also don't use drops unless absolutely necessary, I think the chemicals (acids) make my eyes feel dryer/ more sore. The only thing i would recommend is lower tear duct plugs. Also if you can, making eye drops out of your own blood (not sure where you go to get this done) I have heard is much better for your eyes than commercial drops. I havn't found an eye drop that helps my eyes feel better for more than 5 minutes yet and i've tried dozens. Good luck and keep me posted. Ann

My surgery was August 1, 2006. I have now been diagnosed with Meibomian Gland Dysfunction (MGD). My Meibomian glands are clogged. I am continuing with lid scrubs, Doxycycline, Restasis, warm compresses, and various types of artificial tears. In addition, my surgeon has now put me on a topical steroid (prednisolone acetate) for one week to reduce inflammation. The steroid does help quite a bit, but I can only use it short-term due to its serious side effects, if used for a longer period of time. I read a 2005 study by Dr. Sheffer Tseng (Miami, Florida - USA), who is one of the leading dry eye specialists and researchers. According to this study, MGD can be LASIK-induced and damage to these glands as well as to the lacrimal glands is more likely long-term and not transient, as many doctors would have you believe.

I hope your eyes are feeling better and good luck with your treatment.