Question
I am female & 59 years of age. About 4 months ago I began having dry eye (moderate). I am using Lotemax .5% eyedrops just once a day (because they burn quite a lot), but I was told it is the best treatment to get inflammation stabilized. Is it safe to use for 2-3 months as has been recommended to me? How often should the eye pressure be checked while using Lotemax? I know there can be serious side effects; including causing glaucoma. I have mild blepharitis of the eyelids, which I guess is a cause of my dryness along with medications I was using that dried my eyes out. I was using 50 mg. of Vistaril every 6 hrs. for 4 months, plus 50 mg. Trazadone at bedtime. When Clonidine was added to the mix,(1/2 of 0.1 mg) nightly, is when I began having symptoms of dry eye. I have since stopped the Vistaril a month ago, & cut the Trazadone to 25 mg. & still take 1/2 Clonidine nightly. I don't know if the low doses of Trazadone & Clonidine I take will still affect my dry eye problem, but I'm told much to my dismay, that my eye condition likely won't return to normal even if I stop all medications. I also have fibromyalgia and have thyroid nodules & goiter that could possibly contribute to dry eye.
I am concerned about the possibility of early Graves eye disease. My TSH was at the lowest end of the normal range leaning towards hyperthyroidism. Are there tests to check for early Graves eye disease? I have several symptoms, not protruding eyes.
I also have a feeling of a foreign object in my eye, not just grittiness, but more like a a contact that has been in too long feeling. There is pressure in the eye often as well.
Sometimes I have redness, but often the drops keep that at bay.
I have puffiness under my eyes & frequent eye burning. Sometimes they feel like the muscles inside the eye are tight or sort of pulling. Are these normal symptoms of dry eye?
How do you feel about punctal plugs? I have read that if the inflammation isn't brought under control first, plugs can actually exacerbate problems, and that they only really help if the problem is from lack of tear production from the lacrimal glands, but doesn't really help if the dryness problem is mainly from eyelid dysfunction. What type is best & safest? What if there is a reaction to the silicone? Are they easily removed if necessary?
I know there are a lot of questions here, but I really appreciate your opinions on them. Thank you so much for your time & expertise.
Answer
Dear Debra,
Drye Eyes may result due to some systemic issues as well and Thyroid Disease is a known cause.
Treatment of Dry eyes is directed towards treating the cause and symptomatic relief.
The thyroid has to be under control, but some amount of its effect will happen on the eyes even if under control, so symptomatically your doctor will help see what works best for you.
In the presence of the above symptoms and trials of various remedies, I hope that you are under the care of a corneal specialist as they have the expertise to treat such conditions.
Punctal plugs work well in most cases, however there is a step wise approach to dry eyes and the best way forward would be to have a corneal specialist take care of you.
You may read more about it on www.shroffeye.org
Hope this helps,
Best,
Dr Shroff
www.shroffeye.org
