Bill's Dry Eye Saga

I deal with dry eyes primarily because I have to wear RGP oversized scleral hard lenses. Until I had the eye damage explained below, I have had some form of dry eyes for many years. When I awake in the morning my eyes are dry and somewhat “stuck” until I put tap water on my face and loosen up the eyes. The issue is the same now but I believe exaggerated after the eye damage. But that is the end not how I got here now.

In 1980 I had RK surgery eliminating soft contact lenses. I did well just needing reading glasses as I got older. Until about 3 years ago. While cutting grass some debris got under my goggles and hit my left eye. It hurt a little bit but the pain went away.

Sometime later the lady cutting my hair noticed a grey spot on that left eye. I visited my eye doctor who told me I developed a corneal ulcer and that it was infected to a 85% depth of a hole. The reason I did not notice the problem was that the impact was right on one of the RK cuts, which dulled the pain.

That started me on months of doctor visits to rid the infection. For about 6 months they treated my eyes with an antibiotic cream, which improved the ulcer to about a 50% depth and eventually tapered off and did not get any better. So, the next step was to fit me with oversize sclera hard contact lenses, which cover the entire cornea plus an overlap of about 1/8 inch. Eventually (after several months) it cured the infection, but my eye doctors want me to continue with the hard lenses. Sometime in this cycle I had a tear in my right eye retina which required laser surgery. Since then—for the past 2 years or so—I have visited my VA eye care specialists on a regular basis, particularly the custom fitting of the contact lenses.

So, both eyes have these hard lenses and I am likely to always need them, as I do not see as well with the prescription eyeglasses the VA provided me with. And it brings me to my dry eye saga as the side issue for wearing them. I can only wear them 12-13 hours per day and cannot sleep with them. Since the lenses are hard ones, they tend to dry out the eyes.

During this period, I had to learn a care process for the lenses and dealing with the dry eyes during the day. For cleaning the lenses, I started out with Clear Care. We next tried using the Boston Simplus and Optimum ESC but they were too caustic for the lenses so I went back to Clear Care (which shows in the photo).

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My routine begins in the morning inserting the lenses with special tools but putting a few drops of Ketotifen (prescription) in both eyes to soothe them. Prior to that, I have already put saline solutions such as Major lubricating eye drops to sooth my eyes. I have to wait for about 15 minutes before putting the lenses in my eyes. I remove the lenses from the Clear Care container (see photo) and rinse them first with a sensitive eye saline solution followed by a final rinse with Addipak single use sterile saline solution. One of the issues with these lenses is that once installed In my eyes, I cannot use any solutions such as a “redness reliever” on the lenses as it is not recommended by the manufacturer. So, I am limited to the Addipaks as they are a special sterile solution with no other preservatives.

During the day I use the Appipak’s solution when my eyes get dry from the hard lenses (which is often). For convenience I transfer the solution to a used Visine vial that I can carry in my pocket as I periodically have to add a few drops during the day. See the vial in the photo with the * on it which is this vial and I do confuse it with other solutions.

Finally, I can say that the dry eye issue and these lenses are a significant activity in my life. The good news is that the lenses and laser surgery also save my vision—with technology that did not exist a years ago.

See the photo which shows my “Eye care” area which I have dedicated to eye care. In the photo you can see the tools and eye care solutions I currently use. My eyes are sensitive and subject to allergies.

I see my doctors now every few months and use various treatments like Addipak to help with my dry eyes and clean them.

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Update (September 19, 2018):

I regularly see VA Ophthalmologist and Optometrist doctors - both very competent. Last week, looking through dilated eyes, the Ophthalmologist tells me my dry eyes need help - and they do. When I awake in the morning my eyes are so dry it takes time and eye drops to help before I can put my lenses in. 

So she offered me a procedure which I will describe as best as I found on the Internet (Google it for more details):

punctal plug, also known as tear duct plug or lacrimal plug, is a small medical device that is inserted into the tear duct (puncta) of an eye to block the duct. This prevents the drainage of liquid from the eye. They are used to treat dry eye. Artificial tears are usually still required after punctal plug insertion.

The doctor tells me that tears come into our eyes and the nose with 2 separate ducts. After a minor pain killer she plugs the nose duct so all of the tears go in my eyes in less than 2 minutes. And it made a big difference in less than a week! I wake with much less dryness but she still wants be to use the lubricated drops or Addipaks during the day. So, there may be some folks out there not aware of this treatment.