I'm wondering, if the eyes are no longer dry, will the damage done to the surface of the eye actually recover eventually?

Hello, np1981.

The surface of the cornea, the epithelial cells, will recover from dryness once the tear film is normal, but I am not sure if that is all you are asking. When you speak of damage to the surface of the eye, are you speaking of the temporary dryness damage or something else? Irregularities in the thickness of the flap may persist; in other words, some of the aberrations may continue in spite of an improved tear volume.

Dr Hartzok

I was referring to the damage done to the eye surface due to long term dryness (i.e. 8 months) that has been left "untreated".

I have aqueous tear deficency, however since being fitted with punctum plugs my eyes are moist and wet most of the time (especially at night when I used to have a lot of problems) but despite this a lot of the irritation/redness still persists. What about the white part of the eye, is that different to the cornea in that respect?

The white part of your eye is covered with a membrane, the conjunctiva, and is also subject to dryness. If your eyes are moist and wet most of the time, I don't know why the irritation and redness should persist. The cornea, too, should recover. One possibility is that you have marginal blepharitis and/or meibomian gland disease. These two can reduce the presence of the oil component of the tears and may need to be treated with warm compresses and lid scrubs. You will have to check with your doctor.

Perhaps I'm being impatient? I've only had the plugs in for a month.

You can wait until your next appointment with your doctor but be sure to have him check the meibomian glands and eyelid margins for signs of marginal blepharitis.

How does Doxycycline help this condition? It has been suggested to me by my doctor for "posterior blepharitis".

This link is fairly well written.

http://www.agingeye.net/otheragingeye/doxycycline.php

"Tetracycline analogues such as Doxycycline have been shown to be effective in treating meibomian gland dysfunction. The beneficial effect on blepharitis is via 2 mechanisms: 1) reduction in the bacterial load on the eyelid, and 2) Antiinflammatory action. Doxycycline inhibits the production of free fatty acid (degradation product of meibomian gland lipid). Free fatty acid (FFA) can destabilize the tear film (causing dry eye) and can promote inflammation. By reducing the formation of FFA, eyelid inflammation is reduced and the tear film also becomes more stable.

The treatment duration is typically for several months. The preferred dose of Doxycycline is 100 mg once a day for at least 3 months. Several very important points need to be considered prior to initiating doxycycline treatment."

The inner lining of my eyelids seem quite red and stripy (as opposed to pink), is this a sign of MGD? I notice that when I am more comfortable, they are not as red.

When you say stripy... are the stripes you refer to running vertically? If they are, it would indicate congestion of the meibomian glands (MGD). Hot compresses followed by a gentle digital message of the lids towards the lid margins (towards the lashes) will help reduce the congestion (this is called milking the lids). The idea is to promote removal of the overly-thickened oil, to express it through the orifices along the lid margins.

Yes, they run vertically. I was advised to do the warm compress and massage, but should I be able to "see" anything when I do so?

See the expression from the glands?

Minimally, maybe. If you keep the warm/hot compresses on for extended periods of time, there may be some seepage of oil onto the compress but generally it will still be a minute amount. The more the compresses and the doxy work, the less expression you will probably notice because the oil will become clearer.