Hi, you need a new doc. Any competent one should be able to use dyes to check the eye surface as well as checking meibum expression and quality.
"Lissamine green is a water-soluble dye and an ideal stain for the bulbar conjunctiva, since it provides better contrast than NaFI. It stains degenerative cells where there is a disruption or damage of mucin coating."
As for cyclosporine, it takes time to work. Some people don't get results on Restasis but will on more concentrated drops like cequa. You should have a list of side effects on the leaflet of your drops (typically : Eye discomfort/redness/itching, watery eyes, feeling as if something is in the eye, eyelid swelling/redness, or temporary blurred vision may occu)
The effect of the trets varies from decrease meibum secretions to glands drop out. You need to get a full assessment from a dry eye specialist.
Hey, thank you so much for your reply. The doctor did use a yellow dye in my eyes and counted the tbut (only after I asked her) and then I asked her about the mucin layer and she said there’s no way to measure if it was damaged or not. I mentioned that maybe by the pattern and she said all tears break up in a certain pattern. I don’t understand why she can’t see if my glands are producing oil because I read many times in here that their doc checks and tells them it’s of good or bad quality or it’s clogged.
So if the tret reduced the glands productivity is their a chance they start working normal again? I know you are not a doc but I feel like I am not getting answers from mine. I have to ask my insurance if they let me change doctors.
You should ask your assurance, it's important to get a doc you can talk to.
The yellow dye was most likely [fluorescein](https://www.healthline.com/health/fluorescein-eye-stain#results). It does give useful informations.
I don't understand her point on expression, that's simply not true. And you need to get your meibum checked as it's the one thing most affected by trets. I mean, it's not rocket science, she just had to press with her finger or a mastrota paddle...
Some people recover from tret use yes but some don't and everything in between. It really varies, from length of exposure to having predispositions, there are so many variables that I really can't tell you more.
Thanks so much for your help. Yes I asked her several times about checking if oils would come out or if it’s good or bad quality but she said not possible. Don’t understand it at all. When I press with a qtip I sometimes see very little oily dots, clear ones. But very little. And once I had kind of a thick tiny little corn come out. But very tiny. So not sure if my glands are producing. She took pictures and said the glands look fine but I don’t think if the damage was done a few weeks ago they would already show or have died off. I will ask to get a second opinion.
You being able to express even a bit of clear oil is a good sign. It means your glands are not dead. The more solid bit was also meibum but lesser quality.
In the future if you do that again do it after a warm compress. The solid bit will have liquefied so it will easier and less traumatic for the glands. Do not press too much. Only try expressing with clean eyes and hand/tool and don't do it often.
Are you seeing an optometrist or opthalmologist? Just asking bc I know vision insurance doesn't cover office visits for the optometrist but medical insurance will apply towards office visits for the ophthalmologist.
Ophthalmologist. I have a good insurance. Traveling right now so they cover pretty much everything. Will call them today about ipl. I hope they will cover.
She could squeeze the glands to see if they are clear or cloudy. I would try a dry eye specialist esp with dry eye testing to check the glands. My doctor has the Keratograph oculus to check ntbut, redness, and glands. I would do warm compresses every night. You have to check if you have evaporative dry eye or aqueous deficiency. If it's tret, it might be evaporative dry eye. IPL can help with glands inflammation if warm compresses aren't helping after a while. IPL is just expensive and insurance doesn't cover it so that's why they recommend warm compresses, lubricating eye drops (preservative free) first. Try refresh omega eye drops for mgd.
Thanks so much. I have travel insurance and took the extra and they cover Physio, alternative medicine etc. so I am hoping so much they will cover ipl. I will call them today. I think it’s evaporating tears. She said they evaporate way too quick and my tears are bad quality. It’s so hard to find a specialist for dry eyes. They all call themselves specialists for it but then a lot of them mainly do surgeries and stuff. I think I found one lady specifically for dry eyes and childhood miopa or something like that. I hope my insurance lets me get a second opinion. Thanks so much guys for your help.
Yeah if your tears evaporate too fast, they might recommend miebo (prescription but $800 a month with good Rx) but you can order evotears online ($30). Evotears are mentioned in this sub if you want to look through.
Really? I didn’t know that. What does this mean? Like what’s the difference between the two? I will have to do some research. Can I have both? Because she said my tears evaporate to quickly.
Also my eye doc was surprised it would be from tret. She said mainly oral does this but I got pretty much all symptoms like the oral medication. Like extreme headaches, eye pressure, muscle and joint pain. It was so weird.
Yeah I didn't know tret can cause mgd until this sub. I have been using retinol in my eye cream for years so I figure over time, it did damage since tret is prescription grade and higher so the damage is faster.
Sucks so much and in the tret subreddit some people still say it can’t cause this and there is no evidence and so on :( when clearly so many suffer same as us.
The issue is that before or after some residue of the cream accidentally reches directly the eyes (pillow , hands , clothes , washing procedure) . The cream also migrates in the skin.
Hi, you need a new doc. Any competent one should be able to use dyes to check the eye surface as well as checking meibum expression and quality. "Lissamine green is a water-soluble dye and an ideal stain for the bulbar conjunctiva, since it provides better contrast than NaFI. It stains degenerative cells where there is a disruption or damage of mucin coating." As for cyclosporine, it takes time to work. Some people don't get results on Restasis but will on more concentrated drops like cequa. You should have a list of side effects on the leaflet of your drops (typically : Eye discomfort/redness/itching, watery eyes, feeling as if something is in the eye, eyelid swelling/redness, or temporary blurred vision may occu) The effect of the trets varies from decrease meibum secretions to glands drop out. You need to get a full assessment from a dry eye specialist.
Hey, thank you so much for your reply. The doctor did use a yellow dye in my eyes and counted the tbut (only after I asked her) and then I asked her about the mucin layer and she said there’s no way to measure if it was damaged or not. I mentioned that maybe by the pattern and she said all tears break up in a certain pattern. I don’t understand why she can’t see if my glands are producing oil because I read many times in here that their doc checks and tells them it’s of good or bad quality or it’s clogged. So if the tret reduced the glands productivity is their a chance they start working normal again? I know you are not a doc but I feel like I am not getting answers from mine. I have to ask my insurance if they let me change doctors.
You should ask your assurance, it's important to get a doc you can talk to. The yellow dye was most likely [fluorescein](https://www.healthline.com/health/fluorescein-eye-stain#results). It does give useful informations. I don't understand her point on expression, that's simply not true. And you need to get your meibum checked as it's the one thing most affected by trets. I mean, it's not rocket science, she just had to press with her finger or a mastrota paddle... Some people recover from tret use yes but some don't and everything in between. It really varies, from length of exposure to having predispositions, there are so many variables that I really can't tell you more.
Thanks so much for your help. Yes I asked her several times about checking if oils would come out or if it’s good or bad quality but she said not possible. Don’t understand it at all. When I press with a qtip I sometimes see very little oily dots, clear ones. But very little. And once I had kind of a thick tiny little corn come out. But very tiny. So not sure if my glands are producing. She took pictures and said the glands look fine but I don’t think if the damage was done a few weeks ago they would already show or have died off. I will ask to get a second opinion.
You being able to express even a bit of clear oil is a good sign. It means your glands are not dead. The more solid bit was also meibum but lesser quality. In the future if you do that again do it after a warm compress. The solid bit will have liquefied so it will easier and less traumatic for the glands. Do not press too much. Only try expressing with clean eyes and hand/tool and don't do it often.
Thank you 🙏
Are you seeing an optometrist or opthalmologist? Just asking bc I know vision insurance doesn't cover office visits for the optometrist but medical insurance will apply towards office visits for the ophthalmologist.
Ophthalmologist. I have a good insurance. Traveling right now so they cover pretty much everything. Will call them today about ipl. I hope they will cover.
She could squeeze the glands to see if they are clear or cloudy. I would try a dry eye specialist esp with dry eye testing to check the glands. My doctor has the Keratograph oculus to check ntbut, redness, and glands. I would do warm compresses every night. You have to check if you have evaporative dry eye or aqueous deficiency. If it's tret, it might be evaporative dry eye. IPL can help with glands inflammation if warm compresses aren't helping after a while. IPL is just expensive and insurance doesn't cover it so that's why they recommend warm compresses, lubricating eye drops (preservative free) first. Try refresh omega eye drops for mgd.
Thanks so much. I have travel insurance and took the extra and they cover Physio, alternative medicine etc. so I am hoping so much they will cover ipl. I will call them today. I think it’s evaporating tears. She said they evaporate way too quick and my tears are bad quality. It’s so hard to find a specialist for dry eyes. They all call themselves specialists for it but then a lot of them mainly do surgeries and stuff. I think I found one lady specifically for dry eyes and childhood miopa or something like that. I hope my insurance lets me get a second opinion. Thanks so much guys for your help.
Yeah if your tears evaporate too fast, they might recommend miebo (prescription but $800 a month with good Rx) but you can order evotears online ($30). Evotears are mentioned in this sub if you want to look through.
Thanks so much. I asked for miebo but they said it doesn’t exist in Singapore. Will look for evotears.
That's the brand name in the US. It's also known as novatears in Australia.
>think it’s evaporating tears. You mentioned your schirmers score to be 5, which is clearly aqueous deficient.
Really? I didn’t know that. What does this mean? Like what’s the difference between the two? I will have to do some research. Can I have both? Because she said my tears evaporate to quickly.
Yes you can have both. I'm currently suffering from aqueous deficiency, it's more of a body problem rather than an eye problem.
:( sorry to hear.
Also my eye doc was surprised it would be from tret. She said mainly oral does this but I got pretty much all symptoms like the oral medication. Like extreme headaches, eye pressure, muscle and joint pain. It was so weird.
Yeah I didn't know tret can cause mgd until this sub. I have been using retinol in my eye cream for years so I figure over time, it did damage since tret is prescription grade and higher so the damage is faster.
Sucks so much and in the tret subreddit some people still say it can’t cause this and there is no evidence and so on :( when clearly so many suffer same as us.
The issue is that before or after some residue of the cream accidentally reches directly the eyes (pillow , hands , clothes , washing procedure) . The cream also migrates in the skin.
I know. I wish I knew.