Oct 242012

This is an open letter I worked on with another dry eye sufferer. It speaks from our own experiences as well as the stories of countless others we’ve communicated with and have read about. The letter is on behalf of every dry eye patient in Australia. In it, we outline the problems with Australian protocols for dry eye—namely that they are outdated and far behind the practices in the US and much of Europe. We then outline a number of treatment options unavailable in Australia that are either established or emerging in other countries across the globe.

This letter has been sent to every eye specialist in Australia. We hope that it will help to bring attention to our plight, and foster change in the Australian medical community regarding the treatment of dry eye.


Dear Eye Care Professionals:

We are writing to you today to bring to your attention a fact that is slowly and agonisingly ruining our lives. It is a fact that has led to undue pain, suffering, and debilitation for men and women all over the country. The simple fact is this: Treatment of dry eye (keratoconjunctivitis sicca) in Australia lags far behind the standards in much of North America and Europe. Eye care professionals in Australia are failing dry eye patients every single day by not adopting or pursing the best-practice treatments currently emerging or established in the global medical community. This is not an opinion. It is a fact.

Many of us have spent thousands of dollars visiting countless specialists who, after lengthy waiting periods, have often dismissed or ignored our symptoms and clinical picture, offering minimal, out-dated, ineffective treatments not specific to our condition. It’s depressing enough to suffer with such a chronic and embarrassing disease. To receive no sympathy, along with repeatedly hearing the line, ‘It’s all in your head’—it’s demoralising.

We feel it is time to do something about it instead of sitting back, allowing our symptoms to worsen, and wasting valuable time and money with archaic treatments. We often find ourselves educating the doctors we pay to see, who then find it offensive that we know more about dry eye than they do. We say the above not to demean our eye specialists, but rather in the hope that it will send a message to all health care professionals that we need additional help—that there are more sophisticated treatment options than the usual ‘plug and drop’.

As dry eye sufferers, we suffer from escalating anxiety and stress, debilitating physical pain, and an overall decrease in quality of life. It affects our ability to drive, use a computer, read, work outdoors, or do any fine detail work. This, in turn, affects our ability to support ourselves in employment or even enjoy basic recreational and social activities, which has a profoundly negative impact on our mental health.

Many of us are members of the rapidly growing online dry eye support community. We have immersed ourselves in the many personal opinions, clinical reports, reviews, and well-received studies supporting the use of new, advanced, and even experimental treatments for dry eye. These treatments can help patients in Australia who are unresponsive or contraindicated to the conventional treatments in this country. We hope the following information will provide some valuable insight into the emerging and established treatments currently used in other countries, particularly the United States, with the hope that they may become available to us sooner rather than later.

Every day that passes is a day we lose to this malady. We cannot delay this any longer, and we need your help.

The Problem with Current Protocols

Dry eye is a multi-factorial condition and must be treated as such. There is no one-size-fits-all treatment for us. Unfortunately, it seems very few doctors are willing to take a personal interest in managing the unique attributes of each of our specific cases, or do anything to help us research different therapies to improve our symptoms. We feel forgotten because our disease is not properly understood or extensively researched in this country. The consensus seems to be simply, ‘As long as you can see, then we can’t do anything more.’ This isn’t good enough—in fact, it is a dangerous and irresponsible practice.

Many of us have also faced the problem of dry-eye-induced epiphora. Because of the lack of attention and consideration given to dry eye, the root of this epiphora can be (and has been) missed. This has led to DCR (dacryocystorhinostomy) surgeries being performed when they, in reality, should have been contraindicated. The result is the return of the original dry eye, compounded with the increased drainage caused by DCR—in other words, the most painful and severe dry eye imaginable. This is even worse if the puncta have been over-dilated. The problems with protocols for epiphora are another letter entirely, however.

Current first-line treatments typically prescribed to dry eye patients in Australia are artificial tears, steroids, punctual plugs, basic lid hygiene, and (rarely) scleral lenses. While artificial tears may provide short-term relief, they do not address underlying pathophysiology, and in some cases can cause worsening of symptoms rather than improvement due to the lack of investigation into the original cause of the dry eye. In addition, many over-the-counter drops contain harmful preservatives, which patients are not instructed to avoid.1 Even if they are preservative-free, dosage of any drops in a chronic fashion can be detrimental rather than beneficial to the natural tear film structure and corneal epithelium.

Prescription steroids used to combat inflammation in vulnerable dry eye patients such as Flarex, FML, and Patanol are preserved with benzalkoniumchloride (BAK), a chemical used in detergents. BAK can puncture the corneal epithelium, denature corneal protein, and cause irreversible damage to the eye. Steroid drops are usually prescribed with little concern for their toxicity to the ocular surface, and can cause significant worsening of symptoms in some cases, even in the short term.2

There are many tests and equipment that can be used to evaluate a dry eye patient’s specific conditions and severity, such as fluorescein break-up time measurement, meibography, Schirmer’s test, TearLab osmolarity, evaluation of the lid margin, and bacterial analysis to determine staphylococcal/seborrhoeic dermatitis—most of which are not routinely performed in Australia.

Meibomian Gland Dysfunction and Blepharitis

Regardless of whether a patient has an aqueous tear deficiency (ATD) or not, complaints of dry eye symptoms are usually accompanied by mild, moderate or severe meibomian gland dysfunction (MGD), a common, under-diagnosed disease of the oil producing glands in the eyelid. Meibomian gland dysfunction can occur for various reasons, most commonly blepharitis.3 If there is an ATD, this prevents proper protection for the eyelids, causing a build up of bacteria on the lid margin. The result is a combination of both ATD and MGD, an unstable tear film culminating in dry eye syndrome (DES).

As you hopefully already know, blepharitis takes on two forms: anterior, which occurs when a build-up of excess oil produced by the meibomian glands develops on the outer lids creating a breeding ground for bacteria; and posterior, which develops when the meibomian glands become inflamed and a thick paste-like meibum is secreted, or no oil is produced at all. This lack of oil on the tear film causes the middle aqueous layer to evaporate, resulting in a condition called ‘evaporative dry eye’. Each type requires different treatments, and only anterior blepharitis seems to be the focus in Australia. Posterior blepharitis is far more difficult to treat, but there are now new technologies available that are proving to combat it.

Instructing patients with ATD and MGD to chronically dose themselves hourly (or up to four times an hour) with artificial tears and inserting punctal plugs is incorrect and potentially harmful. Retaining abnormal tears with high concentrations of pro-inflammatory cytokines can cause further inflammation.4 MGD must be treated vigorously first before punctal plugs are used.

It is estimated that up to 80% of dry eye sufferers have some form of MGD on top of ATD, which begs the question, ‘Why are the majority of treatments only aimed at treating the aqueous layer?’ Many of us have been into numerous ophthalmologists suites, with high hopes and a price tag to match, only to find out they don’t even know what a meibomian gland is! This is absolutely appalling and entirely unacceptable.

New Potential Solutions

Meibomian Gland Related Treatments

Current treatment options advised for blepharitis and meibomian gland dysfunction in Australia are lid hygiene, warm compress, eyelid massage, and oral supplementation of omega-3 fatty acids. While these may help patients with mild MGD, studies on omega-3s are largely equivocal. Patients with chronic MGD, moderate to severe evaporative dry eye, and even aqueous deficient patients can benefit from newer much more effective treatment options.

LipiFlow: This is a thermal pulsation system that bypasses the tarsal plate to directly apply heat to the meibomian glands and their contents, allowing for easier flow of oil.5 Currently only Dr. Jim Kokkinakis at The Eye Practice in Sydney CBD has rented this equipment (since June 2012). He immediately began taking frantic appointments from desperate patients from Melbourne, Brisbane, and even New Zealand, indicating our desperation and the travel-burden required for better treatment.6,7 The use of LipiFlow to treat MGD is vastly superior to home remedies like lid massage and warm compress, of which the latter can be dangerous due to potential overheating.

Meibomian Gland Probing (MGP): Dr. Colin Chan at the Vision Eye Institute in Bondi, New South Wales, is the only doctor in Australia that offers MGP. The procedure and equipment were developed by Dr. Steven L. Maskin in Tampa, Florida.8 It has been proven to be highly successful as an initial treatment to unclog blocked meibomian glands along the lid margin. In chronic MGD patients, inflammation causes periductal fibrosis, and only an MG probe can ‘pop’ open these scars that wrap around the ducts, allowing oil to flow naturally.9,10,11,12  This procedure is widely used across North America and Europe. It has become standard practice to help chronic MGD patients. There is a misconception that probing is ‘dangerous’ or ‘painful’, but, in fact, many patients with MGD find it extremely relieving. Maskin Probes are simple to use, inexpensive, and can be purchased from Rhein Medical or their Australian Distributor, Ellex.14

Meibomian Gland Expression: This is the easiest and most cost-effective option to help patients with chronic MGD. As of this writing, we are not aware of any doctors that utilise meibomian gland expression in their toolbox of treatments for MGD patients. Dr. Malcolm McKellar from Christchurch, New Zealand, has performed this treatment in-office with great success. His eye centre website offers instructional information on how to perform the procedure. The idea is to massage the eyelids with forceps to express solidified contents in the meibomian glands, which will encourage production of newer, thinner secretions. In McKellar’s words: ‘It’s not sexy, but it does work.’15

There are adjunct tools developed by doctors in the US such as the Mastrota Paddle and Gulden Expressor Kit, both of which are designed specifically for in-office expression, and are economical and uncomplicated to use. They recommend expression as a first-line, weekly treatment. Subsequent conventional treatments such as omega-3 supplementation, warm compress, etc., can form part of a wider long-term strategy. Meibomian gland expression is also regularly practiced across North America and Europe. The technique can and should be adopted by all eye care professionals treating patients with MGD.16,17,18,19

Haemotherapy Related Treatments

Autologous Serum Drops: Serum drops are prepared from a patient’s blood and can be used in different solutions (20–100%). It should be prepared under sterile conditions in a certified laboratory unit. It contains several growth factors, vitamin A, and fibronectin, and also has an anti-inflammatory effect. Therefore, it has been beneficial in advanced and severe cases of dry eye.20

Serum drops are usually reserved for patients with significant corneal problems. This is a misguided approach, as many dry eye patients benefit from the non-allergic nature of the drops and also find the properties that help promote a healthy tear film, leading to a reduction in dry eye symptoms.

Eye Platelet Rich Plasma (E-PRP): Goblet cell density is low in dry eye patients, particularly in cases of aqueous tear deficiency and cases with chronic inflammation.21,22 Known as the ‘ball bearings’ of the tear film, it makes sense that, with a deficient goblet cell density, we experience a gritty sensation. Low goblet cell density is also associated with a mucin layer problem in the tear film. Artificial tears do not treat this layer of the tear film.

Similar to autologous serum, E-PRP has shown to be highly effective in treating dry eye patients. Clinical studies report significant improvement on lachrymal meniscus and conjunctival hyperaemia and a decrease of corneal fluorescein staining. Post treatment, impression cytology reveals significant increases in conjunctival goblet cells.23 E-PRP has been extensively researched by Dr. Edward Jarka and Dr. John Crane, in St. Louis, Missouri, in the United States. Renowned Australian Ophthalmologist Dr. Brian Holden has also worked with these doctors on this therapy.24

To obtain PRP for therapeutic use, a small amount of blood is collected from the patient. The sample is then centrifuged for several minutes to separate the red blood cells, platelets, and serum. The platelets are then removed and prepared for use in eye drop form. Importantly, when platelets are ‘activated’ (either by coming into contact with collagen, heating to body temperature, or mixing with thrombin), hundreds of anti-inflammatory molecules are released into the local tissue environment. While the very complex mechanisms of interaction between these growth factors, cytokines, hormones and other molecules are just beginning to be elucidated, they are proving to work in concert to restore tissue homeostasis in cases of chronic inflammation.25,26,27,28

In correspondence with Dr. Jarka, he stated:

We believe that the concentrated growth factors that are released when the platelets are activated on the ocular surface have the ability to restore the normal cellular structural architecture that may have changed from a number of environmental or internal factors that deplete these components over time. The result is a continuous intracellular and intercellular signalling that culminates into a chronic dry eye.

The procedure involves the collection of your blood and concentrating it in a cell separator. We use the Harvest Smart PReP system.[29] We then prepare a concentrate into a solution form to be applied to the eye at least twice a day.

We have had enough success with this procedure that we now receive referrals from local physicians and ophthalmic surgeons. We have treated people from many states including Oklahoma, Arkansas, Virginia, and an American citizen currently working in Afghanistan. The cause of these dry eyes has usually been from many contributing factors.

Amniotic Membrane Related Treatments

Amniotic Membrane (AM) and ProKera: It is widely regarded that one common theme throughout all dry eye patients, regardless of the type, is that we all suffer from recalcitrant inflammation of the ocular surface. As such, anything that possesses anti-inflammatory actions could help us, and should be investigated. The use of amniotic membrane in ophthalmology dates back to the early 90s, where it was discovered that the foetal wound healing strategy could be applied to the eye to help reduce inflammation and minimize scarring.30

World renowned pioneer Dr. Scheffer Tseng in Miami, Florida, developed the use of AM to heal damaged ocular surfaces on patients with acute chemical burns, Stevens-Johnson Syndrome, and even pterygium removal with very high success rates. Due to this success, Dr. Tseng now treats moderate to severe dry eye patients with a self-retaining contact lens containing AM, called ProKera.

ProKera is listed by the FDA as a Class II medical device.31 As per his correspondence, Dr. Tseng has successfully treated patients with dry eye using ProKera. He states:

Yes, ProKera can help dry eye patients in several ways. I have used it successfully for them. In short, its potent anti-inflammatory action can surpass steroids and Restasis and more importantly circumvent the potential side effect known to both of them. The membrane also contains abundant nerve growth factor that is known to promote innervations that may help correct the ocular surface deficit caused by dry eye and inflammation so that the neuronal reflex can be improved. The hydration of the membrane instantly helps maintain the preocular tear film stability. For those eyes where the eyelid blinking is incomplete, it also prevents exposure-induced dryness. Once improved, the patient will normally have a “prolonged” period of remission. Because the underlying causes of dry eye are multiple and may not be fully corrected, dry eye can return later on. Nonetheless, the treatment can be repeated

Dr. Allan Panzer of Houston, Texas, has also treated dry eye patients with ProKera, claiming it relieved their pain immediately. One of his long-term dry eye patients was interviewed by Fox News in the US, stating, ‘It felt like I took a pain pill.’32 Numerous other ophthalmologists have been using AM for many years to help dry eye patients, such as Dr. Steven Maskin of the Dry Eye and Cornea Treatment Center in Tampa, Florida; Dr. John Hovanesian of the Harvard Eye Associates; and Dr. M. Wang of the Wang Vision Institute in Nashville, Tennessee.

While it may be difficult to ship cryopreserved AM from the US, the Centre For Eye Research Australia (CERA) located at the Royal Eye & Ear Hospital in Melbourne has been distributing amniotic membrane tissue every year, primarily in corneal transplant patients.33 Attempting this type of treatment for dry eye is just a matter of harnessing the material for modification for a different purpose. If not used in a self-retaining contact lens, AM can be easily temporarily sutured with nylon stitches or fibrin glue to the eyelid margin for the same effect by covering the ocular surface as a ‘biological bandage’.34 We are excited to see that it appears CERA is organising a study for the development of a therapeutic contact lens to culture and deliver corneal epithelial cells, to be compared to AM transplantation.

Amniotic Membrane Extract (AMX): AMX is a novel method of applying amniotic membrane to the eye without the need for surgery or contact lenses. Inventor Dr. Emliano Ghinelli, from Rome, patented the use of lyophilized amniotic membrane for topical application promoting the same biological factors, corneal epithelial regeneration, and inflammation suppression.35 AMX contains an abundance of growth factors, neurotrophins, interleukin antagonists, plus fibronectin and collagen.

In correspondence with Dr. Ghinelli, he gave the following statement:

As inventor I would certainly recommend you AMX to increase your Conjunctival Goblet Cells Mucin secretion and in this way “hold tighter” the aqueous part of your few tears on your ocular surface. Regarding availability: FDA does not allows AMX to be on the US market yet. On the EU field, AMX its currently under evaluation to have the green light. Regarding ProKera: AM or PROKERA are both clever and innovative ways to approach the same diseases.

Dr. Kenneth R. Kenyon from the Massachusetts Eye Infirmary has worked closely with Dr. Ghinelli, stating AMX has application in moderate to severe dry eye.36,37,38,39,40

The use of AMX has also been clinically studied in the US by Dr. Hosam Sheha in Miami, Florida. His studies confirm that:

Although one may attribute AMX’s effect in relieving pain to its anti-inflammatory action, we suspect that such a rapid action in pain relief might be mediated by a yet unknown anti-pain action that deserves further investigation. Ocular surface inflammation was markedly reduced in all cases after treatment. Although the exact action mechanism remains to be determined, the aforementioned effect may be associated with early delivery of AM’s anti-inflammatory active ingredients, which are retained in AMX.[41,42,43]

Other Treatment Options

Tetracycline: Oral tetracycline exhibits antibacterial, anti-inflammatory and anti-angiogenic properties, and can be used systematically.44 The dosing varies between 20 and 100 mg/day and usually lasts for three months in an intermittent modality. Studies confirm that low dose doxycycline improves Schirmer’s and Tear Break-Up Time Scores (TBUT).45 A common side effect is stomach pain, but many patients have claimed this to be far less than the pain experienced from their dry eye.46

AzaSite: The use of AzaSite (topical azithromycin) has been proven to treat eyelid inflammation in both anterior and posterior blepharitis patients, with results indicating more than 50% effectiveness over conventional lid hygiene and warm compresses therapy.47 The presence of lid margin telangiectasias is commonly overlooked. Many eye doctors do not even perform lid eversion tests. AzaSite as well as Lotemax (loteprednol) have also shown to reduce the inflammation in lid wipers commonly seen in patients with lid margin disease.48

Testosterone Eyelid Cream and Drops: This has been studied for over a decade in the US by Dr. David A. Sullivan, Dr. Charles G. Connor, and the now retired Dr. Charles Haines. Transdermal application of 3% testosterone to the eyelid twice a day promotes both tear production and reductions in meibomian gland dysfunction, leading to improved tear film stability. The research has found that testosterone regulates both lacrimal and meibomian glands and direct application to the eyelids allows for direct treatment of both glands.49 When ineffective as an eyelid cream, testosterone can be delivered as an eye drop or even as a sublingual drop. 50

Not currently FDA approved, testosterone cream is only used off-label in the US with impressive results in Schirmer’s tests, Ocular Surface Disease Index (OSDI), and contact lens wearing time. Many doctors in the US currently prescribe this cream for their patients, including the renowned Dr. Boxer Wachler in Los Angeles, California, and Dr. Allan Panzer in Houston, Texas.51,52

Dehydroepiandrosterone (DHEA): Administered in drops, DHEA works along similar principles as testosterone, since we know that androgens play a role in the function of lacrimal and meibomian glands.53,54 Although DHEA has substantially less androgenic activity than testosterone, a study by C.G. Connor and J. Fender demonstrated that 1% DHEA drops produced improvement in TBUT and Schirmer’s test results. In fact, participants felt that the DHEA drops were more effective at relieving symptoms than either plain artificial tears or 1% testosterone drops.55

Although it’s not registered with the TGA, we can use a compounding pharmacy to produce the medicine for us as long as a prescription is provided. While we’re aware of the potential risks of using a compounding pharmacy, we believe that as long as we choose our pharmacy with care (with the help of our doctors), we can get safe, effective medicine.

In Closing, a Solemn Plea

This writing is the culmination of years of experience and research from many individuals, sufferers and advocates alike. We are pleading that you take the time to read our references, gain an understanding into the collective mind of dry eye patients first hand, connect with each other, and bring much needed attention to our plight. We cannot treat ourselves at home. We need your help to have a chance at getting our lives back.

None of the aforementioned treatments are regularly practiced in Australia, and we believe they should be. We cannot afford to travel overseas for treatment, as we are already under huge financial pressure because of our horrible dry eye symptoms. Australia has great scientific and medical capacity, and we can overcome any bureaucratic or technological stumbling blocks through the focus, ingenuity, and support of our eye care professionals.

The Digital Revolution seems to have caused a new epidemic of Dry Eye Syndrome across the developing globe. An estimated 50 million people in the US alone suffer with dry eye of varying severity. The potential market for proper dry eye treatments is vast, and most of us are willing to spend whatever it takes and to risk ourselves as guinea pigs in the hope a particular new treatment can provide relief from the agony. If we have this open mind about treating ourselves, why shouldn’t our eye care professionals allow us to pursue it?

As of October 2012, a very promising drug called Lifitegrast had just completed a Phase III study in the US.56 A small-molecule integrin antagonist designed specifically for the treatment of dry eye, Lifitegrast improved corneal staining scores and the mean discomfort and dryness scores in the 588 patients involved in the study.57 If this sort of research was being done in Australia, we could have had the opportunity to be among the 588 patients involved in this exciting study, and could be seeing results. We want these opportunities.

The severe impact of dry eye is very real to us, not theoretical. It impacts our lives as much as other, better-studied ophthalmological conditions. We want some recognition, and we want the best help available. We’re tired of reading about patients in other countries with easy access to these treatments, fantasizing about the possibilities. The US and Europe are leading the way in helping dry eye patients.58 We must adopt the same strategies, and even form our own innovative methods to counteract this disease before it leads to a spike in mental health problems and disabilities like blindness down the road.

We might consider the formation of specialised ‘Dry Eye Clinics’ (similar to Dr. Colin Chan in Bondi), located in each capital city. In this setting, doctors would have access to the correct tear film diagnostic equipment on a regular basis and thus would be able to help patients attain the latest best-practice treatments. Even if it is an intermittent clinic that operates once a month, this is still better than nothing. We would gladly pay to have a few professionals taking an interest in us, helping us try newer more advanced options and monitoring our progress.

If there are any ophthalmologists, optometrists, oculoplastic surgeons, or general practitioners that would be able to help dry eye sufferers try any of these treatment options, please contact us: AustralianDryEye@gmail.com. There are many of us who suffer together, and we rely on each other for hope, support, and solutions. Let us rely on you, too.

Thank you for your time and your help,

—Dry Eye Sufferers of Australia



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  19. http://www.guldenophthalmics.com/ccp7/MG-Expressor-Kit
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  40. http://www.healio.com/ophthalmology/cornea-external-disease/news/print/ocular-surgery-news-europe-edition/%7B11e2d0b2-2d70-40e2-9fc8-ca63b47154b2%7D/amniotic-membrane-extract-shows-promise-in-treatment-of-corneal-epithelial-defects
  41. http://www.jofamericanscience.org/journals/am-sci/am0611/73_3943am0611_427_433.pdf
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  46. http://www.ncbi.nlm.nih.gov/m/pubmed/8328549/
  47. http://www.eyecareeducators.com/site/new_treatment_for_meibomian_gland_dysfunction.html
  48.  http://www.revoptom.com/content/d/cornea/c/14606/
  49. http://abstracts.iovs.org/cgi/content/abstract/44/5/2450
  50. http://jeffreydach.com/2010/03/19/testosterone-for-dry-eyes-by-jeffrey-dach-md.aspx
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  54. http://ukpmc.ac.uk/abstract/MED/16974129
  55. http://abstracts.iovs.org/cgi/content/abstract/43/12/66
  56. http://www.sarcode.com/
  57. http://www.prnewswire.com/news-releases/sarcode-bioscience-announces-positive-topline-results-from-phase-3-dry-eye-study-of-lifitegrast-175379431.html
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 Posted by on October 24, 2012

  37 Responses to “An Open Letter to All Ophthalmologists, Optometrists, and Oculoplastic Surgeons of Australia”

  1. Very impressive work George, you and your college are to be commended. We could use this in Canada as well. I live in a very large city (1,000,000+) and there is no one place a person can go to access these therapies. I have yet to find anyone very knowledgeable on dry eye and have obtained most of my information from the ‘Dry Eye Zone’ website. I am going to print this off and take it to the optometrist who recently examined my eyes in a clinic that claimed to treat ‘dry eye’. They could not offer me anything beyond what I was already doing which I am sure is way more than they would have offered had I seen them first.

    Kudos to you…Rosalie

  2. Thank you so much for putting together this detailed and comprehensive summary George. Dry eye and related conditions could certainly benefit from a great deal more focus and awareness in Australia.

  3. George, I am extremely impressed with this and totally agree. I suffer from severe meibomian gland dysfunction and, although I manage it, I wonder for how long. I’ve been through the same thing, spend a small fortune on a ‘specialist’ to get sent away with a promotion pack of thera-tears. I found a optometrist who had an interest in Dry Eye and was able to help me get it under control. Still not properly treated, though.

    I’d be very interested to know if you have had a response from any specialists (particularly on the Gold Coast or Brisbane). Your letter is so good I imagine sections of the media may be interested.

    I would like to share in your crusade for better understanding and treatment of DED in Australia (and I’m sure many others would too). For now here is a link to some exciting new research http://www.news-medical.net/news/20130429/IL-1-antagonist-relieves-dry-eyes.aspx


  4. Hi, Thank you for sending your email to Ophthamolgists in Australia.

    I have been suffering from this condition for about 6 years and have found Ophthamologists very dismissive of my problem. It just doesn’t affect my eyes, it affects my whole life as I have been suffering from severe depression for a long time and this is another thing I just don’t need.

    I used to take my mind off my illness by reading, but I can no longer do that because, even though I can read, the next day I shall have the most debilitating headache for three days.

    One leading Ophthamologist here in Brisbane told me my eyes were fine (except for the dryness) and I probably had “migraine headaches” and because I can’t even watch any other television (especially big screen) than my own, he said that was “motion sickness”. He almost tossed me out of his surgery because he was running late.

    I left absolutely shattered as he was my last hope.

    I am now supposed to use strong prism glasses but, as they can’t be put in my bifocals, I have to juggle the two pairs and I don’t want to eventually weaken my eyes with one pair and not be able to use the other. I don’t think they work anyway.

    Sorry to go on like this, but I have really had the endless “runaround” for 6 years. The only thing I haven’t tried is Cyclosporine (Restasis) as it isn’t available in Australia.

    I thank you for your email and if you know of any caring Ophthamologist in Brisbane who handles dry eyes, please let me know.


    • Hi Susan, I understand exactly how you feel.Since you wrote we have heightened our mission for better eye care in Australia and have published our message on a few eye professional journals: Please go to our new website: http://australiandryeye.webs.com/ and you’ll find a list of Doctors who have a special interest in dry eye in your state.

    • Hi Susan
      i was told i could go on restasis in 2012 in sydney, but i chose not to.

  5. I really consider this blog , “An Open Letter to All Ophthalmologists, Optometrists, and
    Oculoplastic Surgeons of Australia

    • Hi Heather, initially, the blog was only to inform people with epiphora about the risks of DCR surgery and to share my story. As time went on I met a local guy with dry eyes and we both decided to do something about the lack of treatments available for this condition in Australia. Thus we wrote the ‘open letter’ and emailed over 4,000 ECP’s and received a handful of responses who claim to have a special interest in dry eye patients.

      We developed the site http://www.australiandryeye.webs.com and have made considerable progress and established connections with the worlds foremost researchers. We want to help those that want to help us, my colleagues site, http://www.tearlogic.com has recently been set up to assist funding.

      We are currently working on obtaining a revolutionary breakthrough into our country that will assist millions with corneal erosions, dry eyes, etc. All in good time.

  6. To all who obviously have spent hundreds of hours writing this letter, thank you. Everything
    you write is absolutely spot on, Australia is far behind in the treatment of this distressing
    condition and I don’t understand why. I have had blepharitis and chronic dry eye since having
    lasik eye surgery 8 years ago and like many others have tried everything to no avail, however
    some of the information provided has given me hope, to travel and have treatment which may
    help me in the near future. My sincere wishes that your work will change treatment options for
    everyone suffering very soon.

    • Thank-you Lynette, my colleague and I wrote the letter addressing the lack of knowledge and recognition of dry eye disease in Australia. The good news is we are making progress and have discovered only ‘two’ very good dry eye specialists in the country (admist thousands of eye care professionals). We are working at bringing more advanced treatments to our shores, you may-be interested in our site http://www.australiandryeye.webs.com

      I advise you contact us before traveling abroad for our preferred recommendations.

      • Don’t think it’s just Australia. It’s everywhere. I believe I once heard on CoastToCoast an interview by an insider stating that the medical system has been set up in such a way as to practically program doctors’ brains to be one-sided. So that they don’t connect dots, or see the forest for the tree’s.

        This explains why the higher up you go in the professions, the more programmed they are to think with only one side of their brains, and are adamantly opposed to the few open-minded, creative, colleagues. Naturally, there will always be exceptions to the rule. who remain not so easily programmed, whether due to background, genetics or whatever.

        Another HUGE problem that none of you seem to mention, is doctors’ staff. They, too, often are totally lacking in compassion, and block people from contacting the doctors – even thru email. I have run into this problem with respect to a top eye doctor, whom I tried contacting with respect to my LipiView pics.

        I’m leaving out the name, as we all know what happens to whistleblowers. Suffice that there was no response. They basically expect you to fly to their locale, without at least offering a pre-assessment.

        So you see, the system is rotten through and through, not just in Australia. I think back about the French Underground, and the Underground Railroad, and tell myself, who is offering an Underground for all the ill people of the world to reach a Safe Haven, where there Cord Blood MSC treatments are offered, as well as Whole Leaf Marijuana to assuage pain…

  7. There are a few optometrists with an interest in Dry Eyes and Dry Eye Treatment. In2Eyes Optometry in Surrey Hills does Mybomian Gland Expression –

  8. Hi. Just been to my GP, he gave me the PRP site to read . Most interesting.
    I was 80 in February,matbe too old to have anything done.
    Thankyou anyway, keep up the good work. Shirley L.

  9. Hi there,
    I just wish to highlight the brilliant work Professor (you have her listed as Dr. On your site) Stephanie Watson. She is incredibly brilliant and has a very special interest in dry eye, and together, we are getting to the bottom of my problems! She sees patients at the Sydney Eye Hospital and at Bondi (BondEyeDocs-I think it’s called, Newland St, Bondi Junction http://www.profstephaniewatson.com.au) plus also at Sydney Children’s Hospital (and I think another private practice or two! I don’t know how she does what she does, she is truly super human!) She is passionate about what she does, and deserves Australian of the year! She is also heavily involved in research, predominantly with the University of Sydney. Much of her work is viewable on the net by Google searching her name. I can’t recommend her enough. In my experience, although it takes time, she tries lots of different approaches befor more ‘drastic’ things and even though an outstanding, brilliant and gifted surgeon, will avoid surgeries if at all possible.
    I hope this information helps someone out there!

    • Hi Rachael, Yes Stephanie Watson is one among a small handful of eye professionals in Australia who has an interest in treating dry eye. Thank-you for mentioning her.

  10. Many thanks for this ray of hope in regards to dry eye treatments available in Australia. I have been a dry eye sufferer for 11 years now, and have had a few treatments over this time – steroid drops, surgery, artificial tears – none of which has made any real difference, and this condition, which as mentioned by many others, has a massive impact on your quality and enjoyment of life. I have found that over the years my specialist, whilst caring, is so overworked due to the lack of ophthalmologists in the state (I live in Tasmania) he has little opportunity, or perhaps interest, to offer any of the new treatments available. Letters such as the one above, give me hope that there is someone out there who is trying to make a change and offer choices for anyone struggling with this very difficult condition. The better informed we are, the more options we have to take control of improving our health for the future. Thank you for caring enough.

  11. What a thorough, well thought-out article!
    Some more MGD therapies not mentioned above are Mibiflo & IPL.

  12. Update:
    It turns out that Miboflo irritated me given my type of situation.
    Any pressure irritates me, as does prolonged heat, as do many drops.

    I have pics showing extreme atrophy (tangled-fused glands)
    The pics were taken =prior= to probing, so much for hysteria re: probing.
    In fact, its probably the preparation with steroids and lidocaine and NSAIDs which make people get reactions.
    Rather than the probing itself.
    I found out most prescrip.stuff either have preservatives, or else are really ointments even if they claim to be “gels” as is the case with Lotemax. Ointments are very damaging.

    While I didn’t get improvement, still, I did =not= get reactions to probing, and that might be because I refused to prep with any that caused me to feel ughy a few days =prior= to probing.

    So all they did was smear a bit of some mild, non-prescrip. “caine” at my margins. That’s IT.

    I’ve also tried exorbitant PRP drops, activated via Calcium Chloride activator.
    Nothing worked. In fact, the PRP caused me worse ill-effects than eyedrops did.

    So the doctor thought it may be futile to try AM for my eye surface dystrophy afraid that lack of lipid layer would just irritate my eye surface all over again.

    BTW, I’m in the U.S. but its too hard for me to get to Florida.

    P.S. Sometimes pure-water drops relieve me better than anything else.
    Though Genteal-severe & Similisan-dry are sorta OK. For now.
    I’m severely sensitive, including severe headaches.
    Best for me are Gabapentin and coffee. Also a certain diet.
    Warning – Ointments and eydrops with too-high PH are very damaging to eyes.

  13. Has there been any response to this well-informed letter for help? I have severe dry dry trying to cope with for over 5 years. Expensive consultations th and all i feel is that money wasted and my eyes are deteriorating more ànd more. I’m tired. This is ruining my life and I cannot find an answer. My nerves are shot to pieces. I’m feel with every month going past this condition is isolating me from life. I cannot take glasses from my eyes for even 5 mins during the day or night, which is also giving constant migraines. Looking forward to your reply. Kind regards. Debbie

    • Hi Debbie, yes we’ve had a few replies and working with optometrists and ophthalmologists for improved treatment of dry eye. In Australia we’ve seen a growth in the interest of treating dry eye with a few specialists clinics set up to treat the condition.

      I can understand how devastating dry eye is. I’ve lived with it for many years and spent a fortune trying to reduce the symptoms. In recent years IPL and LipiFlow has gained recognition for treatment of Meibomian Gland Dysfunction. Have you been diagnosed with MGD?…

      • Hi,

        Thank you very much for your reply. Honestly, I never knew that this problem could be so time consuming, getting nowhere and I seriously don’t know anyone with the problem that I have, which is starting to make me think about everything I do and making me feel isolated. Everyone thinks I’m joking.

        I have tried Restasis, plus every other drop on the market to absolutely no avail – not even one bit of help from these drops.

        I have also tried punctal plugs and scleral contacts to no avail and autologous serum drops.

        Few weeks back $500 ($56 back from Medicare) consultation in Sydney Doctor gave Prednisolone sodium Phosphate 0.5% w/v eye drops – $85 – did nothing. I have been diagnosed MGD. Went there to hopefully have Lipiflow. Was told that Lipiflow was not suitable for me as I do have some oils coming out to coat the eye – however the doctor said that these oils are toxic?? Because I have some oils coming out Lipiflow is not suitable for me.

        What about Meibomian Gland Expression? Is this expensive, painful, does it work, suitable for what’s wrong with me?

        The doctor suggested IPL – is this the laser around the eyes? This is at a cost of $950 per treatment. I won’t know if the treatment will work until around the 3rd treatment and then would take about 5 treatments. Then top up treatment about once every 6 months?

        I really cannot afford this. But this is really scary with my eyesight. Do you have any advice please?


        • Hi Debbie,
          MGD can be notoriously difficult to treat. Despite everything that’s available such as Gland expression and Probing, Lipiflow, IPL, Azithromycin drops, BlephEx, Doxycycline, Scleral lenses etc it can still be very bothersome and expensive. It’s certainly a condition that’s trivialized by family and friends such as, ‘Stop fussing over a bit of dry eyes’. Despite the fact that the eyeballs are 50 times more sensitive than dental pulp, it’s is VERY painful and frustrating to live with on an ongoing basis.

          The above mentioned treatments vary in results for everyone. I’ve known people to have major improvements with IPL, but then symptoms returned upon cessation. Thus, is it worth the cost? The quote you gave of $950 per treatment is excessive. Was that with E-Eye? It should be no more than $300 a treatment otherwise they are just after your money. That price cannot be justified, I’d suggest you try another optometrist or ophthalmologist. It’s safe to use.

          Lipiflow is also rather controversial. I’ve heard more tell me it hasn’t worked for them. However, it’s said to prevent further atrophy of the meibomian glands. Could this be because it’s ‘exercising’ them and preventing rigidity? I’m not sure if it’s worth the gamble with a price tag of nearly $2,000 for ONE treatment. So it was a good thing Lipiflow was not recommended for you.

          The fact you have oil (meibum) coming out of your glands means it’s not ‘hardened’ or ‘toothpaste’ consistency. Have you ever watched a youtube video of Meibomian expression being performed? You’ll notice it coming out like toothpaste. Well yours is not like that, it’s the consistency it should be…an oily consistency. The term ‘toxic’ simply means it doesn’t have the correct levels of lipids (fats). Thus it would be a good idea to get onto a high dose fish oil supplement if possible. Flaxseed oil seems popular in dry eye circles. In fact, you can take both fish and flaxseed oil…no harm in that.

          Did you have Lipiview performed? Do you have a good blink rate and are your lids totally closing? Are you on any medication that can cause dry eyes? Have you tried BlephEx?

          I know all this is expensive. I’ve spent over $20,000 within a 5 year period on treatment for the same condition. This involved regular 2.5 hour trips into the city for scleral lens fittings which they could never fit properly. Flights to Brisbane and Sydney for various specialists. It’s chasing a treatment that seems elusive.

          I’d suggest you find a more reasonably priced IPL optometrist. Simply phone around and ask their prices.
          Let us know how you get on and good luck Debbie!

        • Listen Debbie, I myself am in the US, and its very difficult for me to get to Florida on the off-chance I’d be helped. In any case, I’ve too many other issues going on w/me such as borderline Sjogrens and excruciating foot-neuropathy, plantar-fasciitis, bunions, degenerative & dislocated joints, calcifications, electrosensitivity, etc.etc. What I need most are Systemically-infused Cord-Blood MSC Stem-Cells. Not available in USA due to nefarious consortiums which many are aware of.

          Now to the point:
          I already underwent several MiboFlos, as well as the 2mm probe at my optometrist, and abstained from all drops during the procedure, due to my sensitivity. It turned out that the term “Lotemax-Gel” was misleading, since it wasn’t a gel when opened (rather more like Vaseline textured). So I gave it a trial-run prior to going to my appointment. Since it irritated me – I foregoed using it, and instead, used NO drops at all for the probing (which failed to help anyway). BTW, I returned the Lotemax and weeks later, finally was refunded the big bucks.

          So what does help somewhat? Due to my sensitivity, I sometimes find that using pure-filtered water in my eyes via a dropper helps a bit to desensitize IF followed immediately with either Genteal-Gel-Severe, or else Similisan-For-Dry-Eyes. I’m approx. 75% atrophied (as shown on my LipiView). Furthemore, I also have Bowmans Layer Dystrophy, which is the layer that’s even deeper than cornea. No joke!

          The optometrist kept suggesting I go to an optho he knew of who “supposedly” centrifuges peoples’ blood to create autologous eye drops. It turned out they cost a fortune at $1K (imagine!) – and only irritated me. She claimed they were autologous PRP (supposedly better than “merely” autologous). Its confusing, because just last week, a stem cell clinician told me that if they were a red color, those are not really effective, but rather, amber-colored ones are effective, since the amber ones are truly centrifuged. So basically I feel I was duped for big bucks. The remaining bloody bottles are still in my freezer. At this time, I’ve turned my concentration on my foot and back issues. I often feel like I’m cracking up from all my bodywide pains and sores.

          And I keep getting rejected by stem cell clinics, due to not having any “major” issue they usually focus on, such as MS, Parkinsons and so forth. I often wonder whether they, too, are being strong-armed by the FDA and Big Pharma.

    • Note that I have 75% atrophy of my Meibomian glands, as per my LipiView done recently. I’m not sure what Debbie means about the glasses causing her migraines. I find that eyewear helps keep mositure in, thus preventing migraines.

      Furthemore, Debbie, is Gabapentin available in your area? It helps alot toward relieving headaches, so to me its well worth the accompanying drowsiness. I first take a very weak instant-coffee with creamer & xylitol. Followed a bit later by Gabapentin. You can start out with 300mg 3X a day, then increase to 400mg 3X a day. Is there any sort of Tranquileyes in Australia? If so, it’s more comfy without the foam since the foam itches and is dehydrating.There’s even supposed to be a superior sleep-goggle available at Dry-eye-shop in the U.S.

      I don’t just have MGD to deal with, but also Bowman Layer Dystrophy of the cornea, and also excruciating foot issues that are even worse than my MGD plus corneal dystrophy. It’s basically bodywide breakdown for me, sorta like the Syrian war zone, if you relate to tragicomedy.

  14. i dont mean to be rude, but in the uk there is little being done. one drug, ikervis has to be prescribed by an optician or someone in that field. its very difficult to find relief, mines happened due to mgd too. i can say one thing= more research is being put together many drugs like… regenerx, lifegrast- cant remember its name, and many more. just look it up, ‘dry eye drug development 2016’ there are alot of studies. i get angry as i got it tail end of 17, im now 19. i feel i have no social life, very lonely and worry about my eyes 24/7, i rarely get sypmtoms due to- theralife. there are many other better treatments- biotears, hydroeye. i guess you already know them, please keep trying i know its hard and annoying. my mdg is bad i almost want to die, i hate it! i got my depression ok, then boom! this disease. there is more things being done but the fda only allow if it helps signs AND symtoms hence little options. hope this helps.

    • Hi Natalie, thanks for dropping by and telling a bit about yourself and future treatments. You might be interested in another site a colleague and I created with a list of research reports: http://australiandryeye.webs.com/research …You may-be interested in research into Lacritin or Diquafosol tetrasodium. It’s only been approved in Japan unfortunately, but with the power of the internet?? Some searches you maybe interested in:



      There are also a lot of misdiagnosis occurring and missed ’causes’ of dry eyes and mgd. For example: An eye specialist will rarely analyze current medication!…a source of dry eyes for many people. It’s ironic how they miss it, there’s even research on it: http://www.hindawi.com/journals/joph/2012/285851/

      Having MGD at such a young is age is unfair, we all feel your pain. But the good news is in the past 5 yrs there’s been an explosion of new understandings, and thus new treatments for MGD. Just a few short years ago we didn’t have IPL or LipiFlow for MGD…we certainly do now! not to mention the new eyedrops. So the next few years we’ll move even closer to relief and hopefully a cure!! Let’s hope you enjoy your 21st without the misery of MGD, a lot can happen in two years 🙂 All the very best to you.

  15. thank you for your reply, ill be sure to look it up, very interested in what you posted. im lucky to be able to know what i have and what to do. yes, i guess so, it is unfair, annoying at the most but doing much as possible. i got improvement recently made me so happy i forgot to say about ikervis, apprently 2x stronger and better than restasis for the eyes. inflammation has flared up alot i think, i only produce tears at yawning. so im hoping ikervis will help, i know for lipiflow, it took about 30 years to understand mgd at a good level and develope that technology. i appreciate your responce and positivity in such a difficult state. =) it helps me to continue, i hope they find a cure- they can cure blindness, and near enough cancer with new treatments. why not dry eyes?

  16. Listen Debbie, I myself am in the US, and its very difficult for me to get to Florida on the off-chance I’d be helped. In any case, I’ve too many other issues going on w/me such as borderline Sjogrens and excruciating foot-neuropathy, plantar-fasciitis, bunions, degenerative & dislocated joints, calcifications, electrosensitivity, etc.etc. What I need most are Systemically-infused Cord-Blood MSC Stem-Cells. Not available in USA due to nefarious consortiums which many are aware of.

    Now to the point:
    I already underwent several MiboFlos, as well as the 2mm probe at my optometrist, and abstained from all drops during the procedure, due to my sensitivity. It turned out that the term “Lotemax-Gel” was misleading, since it wasn’t a gel when opened (rather more like Vaseline textured). So I gave it a trial-run prior to going to my appointment. Since it irritated me – I foregoed using it, and instead, used NO drops at all for the probing (which failed to help anyway). BTW, I returned the Lotemax and weeks later, finally was refunded the big bucks.

    So what does help somewhat? Due to my sensitivity, I sometimes find that using pure-filtered water in my eyes via a dropper helps a bit to desensitize IF followed immediately with either Genteal-Gel-Severe, or else Similisan-For-Dry-Eyes. I’m approx. 75% atrophied (as shown on my LipiView). Furthemore, I also have Bowmans Layer Dystrophy, which is the layer that’s even deeper than cornea. No joke!

    The optometrist kept suggesting I go to an optho he knew of who “supposedly” centrifuges peoples’ blood to create autologous eye drops. It turned out they cost a fortune at $1K (imagine!) – and only irritated me. She claimed they were autologous PRP (supposedly better than “merely” autologous). Its confusing, because just last week, a stem cell clinician told me that if they were a red color, those are not really effective, but rather, amber-colored ones are effective, since the amber ones are truly centrifuged. So basically I feel I was duped for big bucks. The remaining bloody bottles are still in my freezer. At this time, I’ve turned my concentration on my foot and back issues. I often feel like I’m cracking up from all my bodywide pains and sores.

    And I keep getting rejected by stem cell clinics, due to not having any “major” issue they usually focus on, such as MS, Parkinsons and so forth. I often wonder whether they, too, are being strong-armed by the FDA and Big Pharma.

  17. George, can you please change my pen name here to Judy, not Minni (see last post). Sorry.

    • Hi there Judy! Your request caused some confusion. I don’t believe the internet dashboard allows me to change people’s names. It may-be a security setting. However, I have sent an email to my website developer for a possible solution. Thank-you.

      • George, I copy/pasted my last response using “Judy” instead.

        So now, can you please delete any post above which states “minni”.
        I assume you are allowed to delete posts?

        So its just a matter of Search & Delete.


  18. Hi Minnie,
    Thank you for your reply. Oh my goodness this is all so confusing hey. I have tried the autologous eye drops which were amber made from my own blood. They were useless. I used them for over a year in hope. Of course that does not mean that they made not work for you. Apparently it depends on the quality of the serum, however my blood tests appear quite good? I don’t think any of these specialists know anything – we are just being used as guinea pigs and to rake in big bucks.
    Good luck

    • I totally agree that we are used as guinea pigs.

      My podiatrist told me that he had gone for PRP for his hip, and that also proved futile.

      So next he’s going for the real thing – I.E. real stem cells. (He’s joining a clinical study somewhere in the States).

      So much for the Red-colored PRP drops (me & my podiatrist)
      …….and the Amber-colored Autologous drops (you)

      Frankly, I hope that all con-artist practitioners who rake in HUGE cash with ZERO returns on our part) get to feel how they made us feel.

      I mean, have they no conscience? It’s not as if I didn’t call & tell them that the drops irritated me – but did the ophtho bother to call back? Nope.

      It’s robbery plain & simple, white-collar or not.

  19. Hi all again I forgot to mention this and you maybe not know it, but there is a petition going on to find a cure and fund more research. I will link it here can you all sign it please and thank you? If that is okay. Tell anyone else too! It’s aiming for 500 people at least and more than half way there. https://www.change.org/p/urgent-attention-research-funding-needed-for-excruciating-painful-dry-eye-disease sorry to bombarde the post or anything. We need many to sign it and remembered here. I didnt start it and your link is included at the bottom too.

  20. Hi has anyone tried doing eye baths using cooled boiled water mixed with sea salt , that is what helped me get some relief from the constant tearing after my failed D.C. R surgery. The doctor suggested I go for another one to unblock my partially blocked tear ducts but I don’t want to go through another Surgery when the scars from the first one are still there.washing my eyes with salt water and using a syringe I push the water down the tear ducts trying to emulate the irrigation technique that the doctors do is what I do now early in the morning and before I go to bed to relieve my excessive tearing problem .5

    • Ibtisam, it’s interesting that you brought this up, because it has reminded me to point out the MAJOR difference between you and “minorities” like myself. See, your cornea’s & eyelid-glands may be, thank God, intact, whereas with me, LEAVING-OUT THE SALT (i.e. using pure, filtered, water, in a sterilized eyedropper), is what brings me relief whenever i feel irritated. I keep the dropper-bottle at my bedside.

      For me, it operates on similar principles as “eczema”. Eczema attains the best relief via cool-water baths, at least that’s what a dermatologist told me. I figured this out thru an AHA! epiphany. See, i deduced that when I cry, my eyes are in agony. Perhaps its due to my damaged cornea’s coupled with my fibromyalgic autoimmune allergies. So I told myself, hey, so many eyedrops include SALINE and/or aren’t thin enough, thus leaving irritating residues. In fact, Dr. Holly, that wonderful dry-eye advocate, used to warn against unnatural, thick eye ointments. So I told myself – why not pure water – which is peoples’ natural instincts whenever they have a boo-boo? They splash on water!

      Note that an expensive eyedrop which the optometrist’s office advised me to try (Retaine) touted to be preservative free, actually had Carboxymethylcellulose sodium 0.5% and i felt it corroded my eyes. So I frankly don’t care how popular it is for most dry-eyers. For me, it was hell, and I don’t like doctors marketing stuff which are potentially harmful. It’s no wonder those virtual-grand-larceny $1,000 blood-speckled PRP drops caused me agony (see my above posting). Those must have been very salty, and perhaps triggered my autoimmune condition to react.

      Another mention, is that “honey” which is very NON-salty, brings relief to some patients as per dryeyezone, though i myself would need to combine the honey with lots of water, at risk of my sensitive-eyes feeling irritating residue upon it drying. It makes sense, because after all, the optometrist had detected that I have corneal erosion, and Lipiview proved that I have severe gland atrophy (MGD). Any wonder that eyes like mine are sensitive, compounded by my autoimmune condition?

      It’s prudent for all eye doctors to ask: (1) Do you have an autoimmune condition, and (2) Network with other doctors who have sophisticated instruments to test patients for: Corneal erosion and MGD.

      Then, if patients have autoimmune conditions AND/OR erosion AND/OR severe gland atrophy, those factors might predispose them to having very sensitive eyes, which may be ultra-sensitive to Saline/Sodium, in which case, advise them to apply filtered-water eyedrops. And it’s also advisable for them to stick to LOW-SODIUM MINIMAL-SPICE diets as well. And do not think that cinnamon, garlic and raw-onions, aren’t spices too! They most definitely fit right in with salt & pepper & high-arginine diets.

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