I had PRK on february 2006. When the doctor saw me for the first time he said... "how strange your tears break as you blink! this is unbelievable! bla bla, you are a good candidate though so let's do it next friday." You have no idea what I have gone through. It has been almost a year and my eyes burn all the time. I don't know why but the plugs seemed to make it worse so I removed them after several months and I begin to feel a little better... My pupils dilate 7 and the starburst and halos are driving me crazy... I am hoping the sclerals or RGPs work for me so I recover my night driving but I don't see how with this dryness. Any advice on dryness besides the restasis, viscotears, genteal, refresh tears, celluvisc???? Why the dryness after PRK? isn't it lasik that causes the excess dryness??? I remember my eyes been dry but I was able to wear my soft contacts (worn them for 16 years), will this get better????and what about this floters??? why do I see these stuff in my eyes after the surgery??? what is causing them??? these black floting stuff inside my eyes doctors say are only in my head but seem to get bigger and bigger and darker????

Gibell,

I am at a loss to know how any surgeon could recommend PRK to a patient with zero break up time. Your epithelium was already compromised and its ability to heal questionable. A very low BUT could indicate a problem with meibomian gland secretion. This is oil secreted from glands within your lids that coats the watery portion of your tears, reducing the evaporation of your tears and dryness. It is important for an eye doctor to check the meibomian gland secretions. If little or no oil can be expressed, then he/she should prescribe 100 mg of doxycycline (oral agent) per day for a minimum of 90 days. If the doxy is helping, then stay on it for at least another 90 days or even longer.

At the same time, have the doctor examine your eye lid margins for redness. Often there is irritation along the lid margins that will make your lids slightly red and swollen. Eye lid cleanser should be used to wash away any scaly deposits and lid debris. Do this daily.

Hot compresses twice a day for 10-15 minutes would be helpful.

Flaxseed oil supplements (from a health food store). Use according to instructions.

Eye drops can help but we are always concerned with any preservatives and the vehicle ingredients. I believe Artist Woman responded to you about some special drops available at the Dry Eye Zone. Many have found these drops to be very helpful.

The floaters are usually not associated with PRK (more often with LASIK) so, I would presume the floaters are coincidental. You need to get to a doctor to examine your retinas very carefully. While certain floaters can be benign, it is critical that you rule out the possibility that you have a retinal tear or retinal detachment. What you are experiencing is not "in your head" but in your eyes. Find another doctor who will examine you carefully. While you are at it, have him/her check the eye lid margins and ask about the oral doxycycline. It sounds to me as though your present doctor has done all he is capable of doing to you and, with your history, I wouldn't suggest he do anything more.

Thanks a lot for your help... another thing before I start to panic, what exactly means retinal tear or retinal detachment? is it associated with the long term use of contacts lenses? because I remember noticing the floaters before the surgery... I just see them more clearly now, maybe the fact one becomes kind of obssesed with trying to reach a certain quality of vision with what there is left in your eyes makes them more noticible. Another question: Would an expert contact lens fitter notice if there was a problem with the retina or is it hard to know?

A retinal tear or retinal detachment can occur spontaneously and is not associated with contact lens use. Most people have some floaters, like you are experiencing, but when they suddenly become more pronounced then you should be examined to see if there has been a change in the retina (back of the eye). Certainly your post-PRK concerns tend to bring these sorts of things to your attention but that doesn't mean they aren't real.

Any eye doctor should be capable of assessing the retina to rule out a tear or detachment. Capability usually correlates with experience so a doctor that examines regularly for retinal problems (dilates the pupil) has an advantage over a doctor who does not dilate. Ask the fitter if he/she wants to rule out a retinal problem or if he/she would be more comfortable referring you to someone else.

about the doxy... is it safe to be on antibiotics for that long, we are talking about months here...

Yes, unless like any other drug you are allergic or experience side effects. Doxycycline is a form of tetracycline, frequently used for acne and ocular rosacea. A list of side effects and precautions is readily available on the internet. If you feel you are experiencing any adverse reaction, then discontinue or check with your physician. IME, most people tolerate the drug well. Doxycycline is better tolerated by the lower bowel than tetracycline.

and what exactly does it do to help the tear problem??????

Increased outflow of meibomian gland secretion (oil) reduces tear evaporation and symptoms of dry eye as measured by Schirmers test and tear break up time (TBUT).


Signs, symptoms, and tear studies before and after treatment with doxycycline.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abs...us&list_uids=9006372

Final sentence under the study results:

"Doxycycline, 100 mg daily, will improve ocular disease and increase the tear break-up time."


The effect of low-dose doxycycline therapy in chronic meibomian gland dysfunction.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abs...s&list_uids=16491814

"CONCLUSIONS: Low dose doxycycline (20 mg twice a day) therapy was effective in patients with chronic meibomian gland dysfunction that were refractory to conventional therapy." (This study suggests that 40 mg/day is effective.)


Ocular evaporation in meibomian gland dysfunction and dry eye.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed...&itool=pubmed_docsum

"CONCLUSION: Patients with meibomian gland drop out, and especially those with low tear production by Schirmer test, have an increased risk of dry eye developing through increased evaporation."

Gibell,

You may also want to read previous posts on this bulletin board. I just did a search under all forums and found that "doxycycline" is referenced in 452 posts.

Dear Gibell;

I am sorry to read that you are having such difficulties with vision distortions and dryness issues. It has been my experience that scleral lenses work very well in addressing many of the problems that you are experiencing. These lenses vault over the cornea and are supported by the white portion (the sclera) of the eye. A special liquid fills the space between the back of the lens and the front surface of the cornea. Vision and comfort are usually very good. Because scleral lenses do not touch the irritated corneal tissue, and this tissue is protected from the environment and the blinking action of the lids, some healing activity may take place.

Edward Boshnick, O.D.,F.A.A.O.
Miami, Fl
www.eyefreedom.com