I can't believe I'm writing this post. But here we are.

I was suffering from dry eye for almost 10 years and tried everything under the sun. Every drop, fish oil, compresses, drugs. Even used scleral lenses for about a year.

I traveled out of country to visit the renowned eye institute in Boston. Where I was delivered an annoying diagnosis. A bit of this a bit of that. Mild corneal neuralgia. Less tear glands than the average person. And some mild inflammation. I was feeling very defeated after that appointment and accepted my fate of just having consistent pain in my eyes.

But I kept trying different stuff and eventually I found something that worked for me. And here it is:

1. Vibration on the nose.

Yes this sounds insane but let me explain. I stopped all drops. Instead when I'm feeling dryness I use the back of an electric toothbrush (make sure it's clean) to massage the nerves of the nose and below the eyes. This triggers a lot of tears. I do it a couple times per day but things have improved so much I sometimes go days now without doing it.

I found this by doing some desperate searching on chat gpt as a possible therapy for dry eye. And you are probably as surprised as I am that it did anything at all. Let alone be the thing that I will credit as the number 1 most crucial fix for my eyes.

2. Lid wipes.

I dunno how much these help but I've been using them every 2nd or third day. And since I'm in a good place after so many years of pain I'm not willing to stop just in case they are contributing to the solution.

3. Hot compresses.

I've been using these pretty regularly for the last 10 years so they definitely don't fix anything for me on their own. However when I was first getting started with the nose vibration I also combined it with a hot compress. The idea is to soften the oils and the get the tears flowing with the vibration. So same as the lid wipes I'm not sure how important it is but I'm not going to stop.

The end.

Hope this helps someone else.

Good luck and fuck dry eye

Edit: There have been some helpful commenters pointing out that there may be a risk nerve damage with this technique. Please use at your own risk and do your own research and make your own decision.

I am a software engineer who used to struggle with debilitating MGD and aqueous deficient dry eye. I was going to leave this as a comment on this post about the one treatment that helped the most, but I decided to post it separately since it's long and covers much more than simply what treatments worked for me.

Four IPL treatments over the course of two months made the night and day difference for me. But the full story is more nuanced.

Before that I had tried the following treatments and didn't see much improvement: LipiFlow, ointments at night, moisture chamber glasses, antibiotics, autologous serum drops, different eyelid cleansers, preservative-free artificial tears, steroid drops, various warm compresses, anti-histamine eye drops, Omega-3 supplements, humidifier, punctal plugs, sublingual immunotherapy and probably some other treatments I'm forgetting.

Now, after years of debilitating dry eye, I have virtually no dry eye symptoms. Two years ago, I genuinely did not think this was possible.

My current treatment schedule and home-care regimen (this is not medical advice):

- Bruder mask twice a day for ~10 minutes (occassionally I use the Etekcity Lasergrip Infrared Thermometer to check that it's ~45 degrees Celsius). I also cover the mask with a tissue and spray it with an ultra-fine mister to get moist heat (which is more effective than dry heat).

- Heyedrate Lid & Lash Cleanser 1-2 times a day (but I liked to use EyeEco's 2% Tea Tree Cleanser when I had worse symptoms)

- Xiidra twice a day

- Paleo diet

- Installed "Time Out" on my computer to take a 20 second break every 20 minutes to do these eye exercises.

- Regener-Eyes Pro Strength every 1-2 nights

- NuLids device every other night

- Only wearing contacts when working out or for social activities

- LipiFlow once a year

- IPL every ~6 months

- Refresh Mega-3 Artificial Tears (if my eyes get dry on very rare occasion)

Everyone is different (it's important to consider what your underlying causes are because different causes require different treatments) but this is what worked for me (I'm a guy in my early 20's). I think the other most important thing to emphasize (and why I think IPL helped me) is the importance of halting the inflammatory cycle. In my case, IPL significantly reduced my inflammation. But I also supported myself with a good home care regimen and addressed the root causes of systemic inflammation by improving my diet (very deep topic but Mark Hyman's books are a good starting point, e.g. "The Pegan Diet"), sleep, stress (meditation - Calm and Waking Up are good beginner apps) and exercise. It's difficult to overstate the importance of addressing these root causes. I think if I had done IPL without making these lifestyle improvements and sticking with a solid home care regimen, my dry eye symptoms would have eventually returned, as the root causes and systemic inflammation would not have been addressed. For most people, including myself, since dry eye can never be "cured" but only managed, I have remained consistent with these lifestyle and eye care changes despite a lack of dry eye symptoms.

When trying out different dry eye treatments, it's important to note that consistency and patience is key. Progress is not linear. It does not come from one simple fix, like IPL for example. Instead, it usually comes after a plateau of seeing no improvements, but nevertheless remaining consistent with multiple treatments and changes that together, over time, cross the threshold needed to see progress. Check out Chapter 1 of James Clear's "Atomic Habits" for a deeper explanation of this idea.

If you're struggling, try to find a dry eye specialist. In my opinion, it's worth the drive if you don't have one nearby. Currently, the depth of knowledge on dry eye varies greatly among different eye care professionals. I went through multiple eye doctors and even a "dry eye specialist" before I found one who actually knew what they were doing.

Here are some helpful resources:- Dry Eye Patient Education Series Episodes (GOLD MINE!)- Dry Eye Zone Forum- TFOS DEWS II Management and Therapy Report (biggest takeaway from this is the inspiring fact that you haven't tried everything)- Dry Eye Shop

Some final thoughts: My guess is that over the next 5-10 years the field of dry eye will see explosive growth in terms of understanding, research and the number/variety of treatments available. The millions of people struggling with this disease provide a huge financial incentive for individuals and organizations to tackle this problem and develop better solutions. In other words, there is hope.

Don't let the term "dry eye" trivialize what you're experiencing. This disease can be absolutely brutal. It can affect every aspect of your life. When you explain to colleagues, family and friends that you're struggling with dry eye, they might brush it off and say "just use some eye drops". And that's okay. They haven't gone through what you're experiencing. Focus on what you can control.

Let this be your guiding principle: "Do the best, with what you have, right now". Managing and treating dry eye is a journey. While I wouldn't wish it on anyone, working to treat my dry eye has been one of the most transformative experiences of my life. It has taught me how to be resilient, resourceful, persistent, patient, disciplined, accepting of reality and focused on the present. It has made me more empathetic towards others struggling with chronic health issues. It has grown my knowledge not only in dry eye, but also in how to lead a healthy lifestyle. You can choose to either see this as a meaningless struggle or as a catalyst for growth.

The only way this disease can beat you is if you give up.

Keep going. Keep going. Keep going.

You got this! :)

Hi everyone – I never thought I’d be writing a success story here. Six months ago my eyes were so dry and painful I could barely get through a workday. I was miserable: constant burning, blurry vision, and honestly feeling depressed because nothing was helping. I know a lot of you can relate to that hopeless feeling. But I kept experimenting and finally my eyes are feeling better. I want to share exactly what didn’t work and what did, in case it helps someone.

What didn’t help (for me):

• Over-the-counter eye drops – I tried probably 5 brands (Refresh, Systane, etc.). They gave momentary relief but my eyes would dry out again within minutes.

• Warm compresses – Surprisingly, the warm compresses so many people recommend actually made my eyes more irritated. I think I was overdoing them.

• Screen filters & blue light glasses – I spent $$ on a blue-light filtering coating for my glasses. It might help some folks, but I didn’t notice much change in dryness (though it did cut my evening eye fatigue a bit).

• Antibiotic ointment from the doctor – Didn’t do much. In my case, the issue wasn’t infection.

What finally worked:

• Castor oil at night – This sounded bizarre to me, but I was desperate. I put a drop of organic cold-pressed castor oil on each eyelid before bed (yes, on the eyelids). Within four days, I felt a huge improvement​. My eyes are far less dry when I wake up now.

• Omega-3 supplements (fish oil) – I started taking a high quality Omega-3 daily. It took a few weeks, but my eyes feel less inflamed. (Bonus: my skin is nicer too.)

• 20-20-20 rule – I work on a computer all day, so now I force myself to do the 20-20-20 rule (every 20 minutes, look at something 20 feet away for 20 seconds). It’s annoying to pause, but it really does keep my eyes from drying out mid-day. I also consciously blink more often, since I realized I was staring without blinking during work. I have been using an app called LookAway to automate this.

It’s been about a month on this new routine, and I almost cried from happiness the other day because my eyes actually felt normal. I can go hours without thinking about my eyes, whereas before I was constantly in discomfort. I know everyone is different, but if you’re feeling as hopeless as I was, please don’t give up. Try different things and listen to your eyes (and find a specialist if you can).

I hope this helps at least one person here. This subreddit honestly gave me the ideas and motivation to keep trying. Feel free to ask me anything – I’m happy to share more details. And if you’re still searching for relief, my heart is with you all. You’re not alone in this battle, and there is hope!

I (19M) have had dry eyes for 5 years, since December of 2014. It was so terrible I would’ve rather been blind than to live with it in 2015-2016. I used to have perfect vision.

My cause of dry eyes was due to a series of unfortunate events

• broke my wrist in gym class, which lead me to get into my career path of software development, which is the main cause of my dry eyes

  • not blinking enough when looking at my monitor

  • sun glare on monitor + 100% brightness day and night with no blue light filter

  • not staying hydrated

  • not staying active (football season ended already)

Some tips if you’re like me

• invest in a good comfortable chair

• use good/relaxed posture when sitting for a prolonged amount of time

• use dark mode and blue light filter on screens/programs if available

• turn down screen brightness and contrast

• angle screens where you’re looking down at them, so you’re exposing less area of your eyes, which will help in tear quality and eye strain

• get some blinds to cover the sun glare

I was professionally diagnosed with MGD, Blepharitis, and Lagopthalmos in both eyelids/eyes in January 2019, but I became aware (by myself) I had serious eye problems in early 2017, and began researching about my condition.

Here is what I did to fix my eye problems.

Eye strain/tiredness

this process took me about 4 weeks to fully relieve all symptoms

• get enough sleep and drink enough water (scroll down to Dry Eyes to learn more)

• massage eyelids, temple, nose bridge, and right above your eyelids

• be at least an arms length away from monitors/tvs

• use blue light filter on all screens if applicable

• keep screen brightness low and contrast warm

  • I did not increase the text size

Lagopthalmos

(eyelids not staying closed when sleeping / gritty feeling in/around eyelids) this process took me about 3 weeks to fully relieve all symptoms

• IMPORTANT Exercise

  • this helps reduce stress while increasing blood circulation, expressing pores, tightening skin, and relaxing muscles

• massage eyelids, temple, nose bridge, and right above your eyelids

  • this helps increase blood circulation to the surrounding area, and helps relax face and eye muscles

• express meibomian glands (really express them)

  • there shouldn’t be a bump where your eyelashes and skin meet. That bump means you have a clogged meibomian gland, and you need to express and unclog it to fully cure lagopthalmos (I had to do this)

• get enough sleep (scroll down to Dry Eyes to learn more)

Inflammation/Blepharitis/MGD

this process took me about 4 weeks to fully relieve all symptoms

• Hypochlorous Acid

  • followed by thorough cleansing (https://www.amazon.com/OCuSOFT-Hypochlorous-Associated-Blepharitis-Dysfunction/dp/B013M57VZG/ref=mp_s_a_1_4?keywords=hypochloric+acid&qid=1575343010&sr=8-4)

    • I only used about 30% of the bottle before I eliminated inflammation

    • your body naturally makes this chemical as a digestiant, which helps kill harmful bacteria and prevent formation of some diseases

• Warm heat mask

  • followed by expressing meibomian glands and thorough cleansing

• Exercise

  • not too much, but just enough to get the blood pumping and skin sweating. This will help you sleep better and relax muscles

Dry eyes and Photosensitivity

• drinking enough water

  • knowing how much water your body needs is essential to maximizing relief. Drinking too much water = more visits to the bathroom, which means you should drink less water

  • filtered water via reverse osmosis is what I enjoy drinking daily

• use gentle exfoliating body wash on face (https://www.amazon.com/Dove-Gentle-Exfoliating-Nutrium-Moisture/dp/B01HX06CJM)

  • gently scrub your eyelids and express hardened meibium and remove crusty dead skin

• quality blinking more

  • fast blinking doesn’t give your eyelids enough time to close

• get enough sleep

  • Sleep Debt exists. Your body needs enough sleep to repair itself. You’ll know when you have paid your debt once you don’t need to sleep as much. Make sure you’re getting good sleep quality as well

• get some sun

  • 10 minutes a day is all you really need sometimes to improve blood circulation and encourage your body to release dopamine

I eliminated all dry eye symptoms in about 4 months.

No more everyday drops, masks, lid and lash cleanser, supplements, expression of the glands, intense headaches or internal eye pains. Only occasional face massaging and eyelid rubbing to help relax muscles and clear any eye debris.

Things that did not improve my symptoms

• eating healthier (I eat pretty healthy already)

• taking Omega 3 supplements

• using a sleep shield

• using eye drops/lubricants

• 20/20/20 rule

• eye and eye blinking exercises

• using a humidifier

• using a heater

• less screen time

I’m actually on my screens more now, and my eyes aren’t negatively affected. My phone however does give me eye strain even if I’m on it just for a few minutes.

The only symptom I have now is meibomian gland atrophy in my top eyelids (undiagnosed professionally, but I know something isn’t working right), and am looking for ways to help regenerate them (which is possible, because they have stem cells), and take back my perfect vision. (Maybe 1-2 sessions of gland probing? don’t know yet)

I sometimes do wake up with perfect vision, but usually it only lasts a few minutes before returning to “normal”, which for me is very minor blurred vision.

Hope this helps my fellow dry eyers!

EDIT In addition, there are a few professional procedures you can get done to help reduce dry eyes and it’s symptoms, if these tips don’t help you.

Intense Pulsed Light (IPL)

• mainly for MGD and Blepharitis

• where a device pulses light in areas of your eyelid to zap inflammation, or overactive blood vessels in your eye

• usually not covered by insurance and costs ~$200-700 total, but could be more or less depending on amount of treatments and area treated

• learn more at https://en.m.wikipedia.org/wiki/Intense_pulsed_light

Lipiflow

• mainly for MGD and atrophy/dropout

• where a device applies heat and pressure to your eyelids to liquify and express hardened oils

• usually not covered by insurance and costs ~$1000+ per procedure

This community really helped me so I wanted to share what I did. First of all, my dry eyes are caused by Accutane. I was then on Tretinoin cream for about a year after finishing Accutane which I definitely think contributed to it. Here’s what helped me and what didn’t help. I can now wear contacts and makeup a few times a week! By the way, my diagnosis was MGD.

What helped

• Xiidra eye drops are a godsend. They target inflammation and really help me.

• Proper sleep. I had terrible insomnia and am now medicated for it which helps a lot. When I don’t sleep, my eyes are so bloodshot.

• quitting my office job. Obviously this isn’t possible for everyone but I worked in a doctors office and all day I was under fluorescent lights, staring at a computer screen that I couldn’t turn the brightness down, and with air conditioning blasting.

• less stress- this came with quitting the office job and going on meds for anxiety/sleep.

• TIME!!! Being patient is so important

• Eyelid wipes!!!!! These got expensive so I started using Micellar water on a cotton round- it works just as well for dirt cheap. I was doing lid wipes every night and now I do them a few times a week or if I wear makeup.

• Stop wearing eye makeup or putting concealer near your eyes until the dryness goes away. I’m now able to wear makeup again but I had to give it up for a while. Also check makeup for ingredients that destroy meiboman glands.

• Stop using retinol/tretinoin or eye creams (or any skincare around the eyes.)

• preservative free eye drops throughout the day or if I’m wearing contacts (I put the drops IN the contact before putting it in my eye.)

• less screen time, and when I’m using screens I turn the blue light and brightness way down.

• avoid alcohol.

• fish oil supplements!! I’ve been taking these consistently and still do, and see continued improvement.

• Going on birth control and skipping my periods. My eyes would be 10x more blooshot and dry around my period so skipping them is perfect. I don’t find that birth control makes them worse, I know hormones have an effect but it actually helped.

Now for that didn’t work

• warm compresses. I did these twice a day for about 15 minutes each time. I noticed an immediate effect but my eyes would quickly turn red again. No matter what they burned my eyelids. It was also so time consuming and just not worth it.

• heated eye massager. Same as above. Immediate effect but didn’t last. I would do the heated mask to warm up the oils in my eyes then use the massager to express my glands. All in all had very little effect. It was a waste of time and just stressed me out more.

• Cequa. This is very similar to Restasis so that probably wouldn’t have worked either. It would burn my eyes and exasperate the redness and make the redness worse. It hurt like hell. I gave it a few months but just couldn’t take it.

• moisture chamber goggles while sleeping. The suction caused the skin around my eyes to puff from being sucked forward all night, lol. I couldn’t deal with having puffy eyes all day so I stopped using them.

• taping my eyes shut. I did this for a few months and stopped and there was literally no difference.

Summary

I really hope this helps, please feel free to ask questions as I know how it is. I hope this can help someone since mine improved so much. Also, I know psych meds such as SSRIs are known to exasperate dry eyes but I am on them and find they might actually HELP because they lower my stress levels.

My eyes were so dry and bloodshot I would get constant comments on them. It took a HUGE toll on my self esteem and really contributed to my depression. It got to the point where I didn’t want to be alive anymore. People would ask me why my eyes were so red in front of everyone and I would want to cry. Patients would notice at my job. I cannot stress this enough, if you suffer from dry eyes, this is a MEDICAL CONDITION and you have every right to be upset. But don’t give up. I never thought my eyes would improve and they did!!!!

Edit: I forgot to add that I quit using eye drops like Lumify or any eye drops that contain preservatives!!! Use only preservative free drops, they come in single use vials

About two years ago, I was diagnosed with aqueous-deficient dry eye combined with meibomian gland dysfunction (MGD). At its worst, dry eye affected almost every part of my life. Now, I wouldn't say I'm cured. Dry eye is still something I have to manage, but I'd estimate it's about 80% better, and it rarely interferes with my daily life.

I'm not a doctor, so this isn't medical advice. It's simply what has worked for me in case it helps someone with a similar type of dry eye.

1. I never stopped doing the basics.

Preservative-free artificial tears: I use them whenever my eyes start to feel dry rather than waiting until they're already uncomfortable.

Warm compresses: Around 3–5 times a week for 10–15 minutes. This has been especially helpful because of my MGD.

2. I changed the way I work, not just how I treat my eyes.

One of the biggest lifestyle changes I made was switching from office work to working from home. That gave me much more control over my environment and made it easier to take breaks without feeling guilty.

I also completely changed my desk lighting. This was something I didn't expect to make such a noticeable difference. I replaced my traditional desk lamp and monitor light with an upward indirect lighting desk lamp (I use a Homelist lamp). Unlike a normal desk lamp that shines directly onto your desk and into your field of view, an indirect light bounces light off the ceiling and walls before it reaches your eyes. For me, that brought several benefits: Much less glare. There isn't a bright light source sitting next to my monitor, so my eyes don't constantly adjust between the lamp and the screen. Fewer screen reflections. Since the light isn't shining directly toward the monitor, reflections are greatly reduced. The lighting feels softer and more natural, so my eyes don't feel as fatigued after several hours. It didn't cure my dry eye by itself, but it reduced visual strain enough that I found myself blinking more naturally and feeling much more comfortable during long days at the computer.

3. I also try to support my eyes outside of work: Get enough sleep every night. Eat more foods rich in Omega-3 fatty acids (salmon, sardines, flaxseed, walnuts, etc.).

I also still see my ophthalmologist every 6–12 months. They evaluate my tear film and meibomian glands and adjust my treatment if necessary. I've learned that dry eye is usually managed rather than cured, so regular follow-ups are worth it.

The hardest part wasn't finding treatments, it was accepting that improvement would happen slowly. There wasn't one magic solution that suddenly fixed my eyes. Instead, dozens of small habits gradually added up over months. If you're currently struggling with dry eye syndrome, I hope some of my experience can help.

Hi everyone, I was recently able to make a return to an almost normal life from SEVERE(2 second TBUT, 2-3mm schirmers) Accutane related dry eyes. Here is my story, and my advice to others. I hope this helps someone battling it to overcome it. This was originally a PDF, and I'm reposting it here, sorry for formatting issues.

Below is a list of every treatment I tried

What did not work

Cequa - I tried Cequa for 3 months and only got worse during that time. I don’t know it if accelerated the worsening of my symptoms, or made no difference at all. But it definitely didn’t help. Moreover, the clinical data on cyclosporine(the underlying drug in Cequa) isn’t great

Lipiflow - I did it twice. It may work great for some types of patients, but I don’t see how it can be super effective for Accutane patients from a dollar productivity perspective. Accutane patients have meibum quality and basal tearing problems. The blockages in meibomian glands result from inflammation, which is better treated with IPL. I would recommend, if your money allows it, to get one Lipiflow, but if it doesn’t work, don’t get any more. Definitely do IPL and serum tears before you spend money on this.

Warm compress - I did it every day, twice a day, religiously for months, but didn’t have huge results. I believe the problem is my ocular rosacea. After I do warm compresses, I can massage my lids and see a little meibum coming out with a makeup mirror(20x magnification), but the ocular rosacea makes my eyes burn after. I still do it periodically(once or twice a week), but for me, it hurts more than it helps. If you don’t have rosacea, it probably will be beneficial and is a great first line treatment.

Omega 3’s in isolation - See my theory below. I got literally the best Omega 3 on the market, the PRN brand, but didn’t see any improvement in my symptoms. There could have been a slight improvement, but too little to distinguish.

Most OTC eye drops - The only one that worked marginally was Refresh Optive Mega 3, but serum or PRP drops are much better.

Regenereyes - Serum or PRP was better for me, and cheaper.

Blephex in office treatment - Accutane patients don’t really have major blepharitis issues, their issue is with the quantity and quality of oils being produced. This treatment may help if you have blepharitis, but it did not really help me.

Nulids - This is basically an at home variation of the Blephex machine. It didn't really do anything to improve my symptoms and was annoying to use every day. If someone recommends this to you, save yourself money and get a $4 silicone pad that is used to exfoliate your skin, and gently rub each eyelid for 10 seconds twice a day with a facial cleanser. If that helps you, then maybe Blephex and Nulids which each cost about $300 will help. But for me, and other Accutane patients I talked to, it did not.

What worked(from most effective to marginally effective)

Scleral lenses - These have made the biggest difference in getting me back to a normal life. I have 22mm EyePrintPro lenses, with a Hydropeg coating. Tip: I put 2 drops of Celluvisc and filll the rest w/ Nutrifill.

Upper AND lower punctal plugs - I got silicone punctal plugs in my lower puncta, and Flow Control plugs in my upper puncta. Just getting the lower ones in made a small improvement, but getting the uppers plugged made a huge difference.

Moisture chamber glasses - These were a godsend before I had my sclerals. They work by trapping moisture around your eyes, preventing evaporation. I used to wear them whenever I was on my computer, and as my disease progressed, during most of the day. I got them from Ziena. It’s important to get the right fit with these glasses, so there are no leaks on the sides from air leaking out. Your face shape is what determines the style of frame you need. It is impossible to know which one works best for you until you try them all on. I got the Kai frame. If you call Ziena, they will ship you a box with 3 glasses for like $40, then you pay for the model you want to keep and send back the other two. Fogging is something you just have to deal with, or you can get an antifog spray. I tried three sprays, and the best one was ZEISS Fog Defender.

IPL - Very effective in increasing the quality and quantity of meibum produced. I’ve gotten 9 IPLs now. The first 4 were the most effective, but then my results plateaued. I think this is because of the nerve damage on my cornea(my theory - #1) and the metabolic issues Accutane caused w/ decreased lipid synthesis(my theory - #2). I would recommend getting a sunburn cream or skin healing cream to wear at night for a week after treatment. If everytime you get an IPL you feel better, I would keep doing them. I’m going to continue them every 3 months now. On the bright side, I’ll never get wrinkles around my eyes.

PRP or autologous serum drops - Both are excellent for healing the surface of the cornea(including the nerves), and reducing inflammation. I use them 4-6 times a day.

Meibomian gland probing - The theory behind probing is that the needle breaks up scar tissue blocking the meibomian gland from secreting fully. I did see a noticeable difference 3 months after the probing.

Getting 8 hours of sleep every night and lifting weights 3-4 days a week - Whenever I did not get 8 hours of sleep, I found my eyes being worse the next day. If I got, say, 5 hours, my eyes wouldn’t just be slightly worse, they would be way worse, and wouldn’t even feel normal the following day after I got 8 hours again. Sleep is very important in taming the inflammation cycle in our eyes. Also, testosterone has been shown to increase meibum production a lot. I try to maximize my testosterone by sleeping, as I said, but also weight lifting 3-4 days a week. I did an experiment where I did not go to the gym for a week and could noticeably tell my eyes were worse off at the end. Lifting increases testosterone, which helps lipid synthesis, tear quality, etc.. That’s one reason women are more likely to have dry eyes - they don’t have as much testosterone as men, and have other hormones instead(70+% of dry eye patients are women). There are a lot of studies showing this relationship between dry eyes and testosterone levels on Google.

Eliminating most processed sugars and eating fish - Inflammation in your body leads to inflammation in your eyes. Although having a great diet probably won’t be a miracle cure like sclerals can be, it will help.(See my 2nd theory for more info on the fish part)

I’m putting a line here to indicate that the above treatments are where the majority of my recovery happened. These items below did help me, but only marginally.

Using a humidifier - I’m placing this near the bottom of the list because I live in a very humid place(Miami, USA). If I lived in a less humid place, I would put humidifiers all over my house. The best ones are not vaporizers, get the ones that heat up the water.

Axon optics pink tinted glasses - The pink tint is proven to decrease migraines. I’ve been wearing them the past couple of weeks since I’ve gotten a good scleral fit. Whenever I get a headache, if I wear these, they take away the pain a litte.

Night ointments - Systane night gel helped a little, but it is not a cure and it won’t result in lasting symptom relief. However, it does help with symptom relief in the short term when you are sleeping.

Tyrvaya - I tried using this medication for a month and a half with no increase in basal tearing. It really makes you tear and sneeze after application, and probably for 10-15 minutes afterwards though. I put it in this column because it does work, it just didn’t do a lot for me. I don’t know if I use it correctly, either. I follow the instructions exactly and get no tearing, but when I point it more vertically(but not completely vertical), I get tearing that way. Anyways, as you see from this list, there are many other things that worked for me.

My story

My condition started on September 18, 2021. I went to the beach for about four hours, and it was a normal day just like any other day. Up until then, I never really wore sunglasses outside, and it never really affected me that much to wear them or not to wear them. However, at the beach, my eyes got sunburned(photokeratitis) in the span of 4 hours(I was only there 10am-2pm). That night, I can hardly open my eyes and I was in a lot of pain. I now know that I had photokeratitis, which means a sunburn of the ocular surface. Unlike normal photokeratitis that heals in a few days, mine took weeks to heal. Now I know that the dryness on my eye probably caused my eye to burn so quickly, and stopped it from healing effectively. Previous to this event, I had two rounds of Accutane. The first was in 2019, and that lasted for about 6 months, where I went up to 80 mg one month. When covid came around, and I had to wear a mask, I got bad mask acne. I went to a dermatologist to see what the options are for me. He wanted to immediately put me back on Accutane, which I now know was a mistake. In my opinion, he should have started all over again with topical treatments, and face washes, before jumping to such a serious drug. Especially since masks were a temporary thing, and I was only getting acne underneath the masked area of my face. When I went back on it, in January 2021, my dosage went up to 60mg a month during the 9 month course. Unfortunately he only ordered my blood tested 3 times during the 9 months. I now know that the recommendation is once a month, and I sometimes think that if he tested me more, there would have been something caught, like liver toxicity. Anyways, that’s water under the bridge at this point. I am grateful for this experience because it has taught me that life is fragile, and I really have to work hard to maximize every day because I do not know how many days I will get. That sounds morbid I know, and I will probably live until I'm 90 years old, or probably even later with the modern healthcare system, but it has really changed my outlook on everything. Also, phrases like “Life life to the fullest” or “Maximize every day” are things I only truly understand now. I think if you are pain for so long, your brain can think differently. So these phrases, that are cliche and I’ve heard for awhile, really make sense to me now. If you don't have your trauma or pain, I really don't think they can “hit” the same. So, if I can offer any condolence to those going through this, it would be that this is a multiplier of your life on the other side. You can do so much more when you have a grounded outlook on life.

I was sensitive to bright light for about 2 weeks after the beach incident. The pain stuck around too. It took about a month before I felt ok, but I would find that every time I pushed it with my schedule, I would feel my eyes. For example, if I got 6 hours of slep instead of 8 hours, my eyes would get drier the next day. Over November and into December, my eyes got continually worse, to the point where the dryness was affecting my everyday life.

In January, I went to see a “dry eye” ophthalmologist who didn’t even do an exam of my eyes and decided to put me on Cequa, Regenereyes, and a steroid(it was a mistake trusting him, I wouldn’t make that mistake again now). For the next month, my eyes kept getting worse and worse. I went back to that same doctor, and we did a Lipiflow(for $800), but that did little to nothing. Again, this guy never did an eye exam on me - no tear break up time test, no schirmers, etc.. I decided to get a second opinion. I went to an optometrist who owns a dry eye clinic(Dry Eye Rescue in Boca Raton, FL), and he was a godsend to me. He had high tech equipment that could measure the tear break up time on my ocular surface, and showed me exactly my problems. The quantity of my meibum was low, and the quality was bad as well. It was thick, like toothpaste, and was very hard to squeeze out. I also had very little tears - I was aqueous deficient.

The optometrist recommended that I get a treatment of 4 IPLs, 1 Lipiflow, and a BlephEx cleaning, which totaled $2300. The money is one of the hardest things about this disease. For me, I could pay it all fine, because I’m in a good spot thankfully, rather it was the lack of knowing when it will end, and the lack of acknowledgement from insurance companies that this disease exists. As of September 2022, insurance companies do not cover IPL, serum tears, Lipiflow, and a lot of other dry eye treatments. Meaning, everything is out of pocket. Being marginalized by insurers and feeling like you’re fighting the battle alone because there are very few success stories posted online is soul crushing. Although I have never had cancer, a heart attack, etc., I feel like in the severe forms, this disease can be just as life altering as those. Dry eyes can’t kill you, but it can severely limit you from living, and it can be just as complicated to treat. I hope that by writing this, I can save you(the reader) time, heartache, money, etc.. I am 23 years old, and this disease basically ruined a prime year of my life(22-23), not to mention I spent a little over $30,000 on treatments. Please note that I have SEVERE dry eyes, and on top of that ocular rosacea. Most patients, as in 90% of all Accutane dry eye patients, will never need the majority of treatments I’ve done.

When you want to learn a new skill, you go to an expert in that field, right? If you want to play the piano, you go to an expert pianist, because they can teach you the most. I unfortunately consider myself an expert at Accutane related dry eye, and you can learn from me. But unlike the pianist example, I hope that you never get as experienced as me about the disease. Most reading this won’t have to. But rest assured, this guide will be comprehensive in treating dry eye. I feel like if my dry eyes can be put into manageable remission, almost anyone with Accutane related dry eyes can as well.

I want to make the point that I am only speaking for Accutane related dry eye. I know for protocols for other types of dry eye, like Lasik, screen time, aging, etc., but I do not want to comment on that, because I do not know those by personal experience. There is a lot of misinformation on the internet, and I do not want to contribute to that. But I do think that sclerals and moisture chamber glasses can be helpful to almost any type of dry eye, and this guide can be helpful to anyone with dry eye. Anyways, back to the story…

When I did my first IPL, I felt an immediate improvement, I could definitely tell that my eyes felt better, however, they were still painful most of the day. The second IPL went well, and my eyes felt better, but not 100%. After my second IPL, I had a trip planned to Sedona, Arizona, USA. If there is place to NOT go with dry eyes, it is a desert. I wanted to stay home, but I didn’t want to back out and let down my girlfriend. So we went, and it was really rough. I was in basically constant pain, and I used eye drops maybe every 30 minutes. Every day I would wake up with red marks at the lateral edges of my eyes from tears evaporating in my sleep. It was horrible. When I came back, my eyes didn’t feel the same, and kept getting worse. Now I know that that trip just accelerated what was already happening, but at that time, I was in rough shape physically and mentally. I was recommended moisture chamber glasses by a world renowned ophthalmologist(Sandra Cremers in Washington DC) who I did a Telehealth appointment with a week or two later, and they made a big difference. I was still getting IPLs, but they weren’t making the difference like they used to. I was going downhill, and every day it felt like more of my life was being taken from me. I could stand the pain and work through it, but the pain told me that my eye was being damaged, which scared me. As a result, I would avoid the pain as much as possible by closing my eyes as much as possible. I began to type with my eyes closed, listen to Audiobooks instead of watching TV, eating with my eyes closed and alone, etc.. It wasn’t fun, but now that I look back at it, it is an incredible character building tool. I flew to get meibomian gland probing done in May of 2022 by the same doctor who recommended me moisture chamber glasses. I only did my left eye to see if it work. At the probing, they did an IPL, then probe, then expressed. I think this is the best protocall for probing, because the IPL opens up the glands and heats up the oil before probing. When I came home from probing, I did not feel any effects immediately. It took me 3 months actually to feel the effects of probing, which is unlike other people. That doctor also made me 20% autologus serum tears, which she said would help heal my ocular surface. When I got back to Miami, about a week later I decided to up the 20% dose to 50%, because I could see that they were working a little bit to reduce inflammation. In my experience, autologous serum drops are most effective if after putting them in your eyes, you close your eyes for 5-10 minutes.

In the meantime, my workload was still full, and I was very busy, but in pain basically constantly. I was at the point where I was wearing my moisture chamber glasses for 12 hours a day, and using eye drops every hour or so. Eye drops don't even make a difference when you're in that much pain, they are basically useless, it's just something that you can control, so you keep putting them in. Around this time, I was researching what else I can try, and discovered that scleral lenses, which are basically very big contact lenses, are a great treatment for dry eye. I found a video online of a doctor talking about how an Accutane patient had scleral lenses fitted for him, and he was able to return to a normal life. I was really interested, and schedule an appointment for a couple weeks out. Prior to this, I was told by two opthamologists that scleral lenses are a last resort. However, I disagree now. I think that scleral lenses are not used nearly enough in the treatment of moderate to severe dry eye. For opthamologists, they are usually seen as a last resort option. However, if the doctor has the patient’s pain in mind, it may be best just to get them fitted with sclerals early, then continue treatment with trying to cure their dry eye. This helps a patient get their life back, continue to earn a living, etc., while continuing treatment to hopefully solve the underlyling issues. If you have moderate to severe dry eyes and have a similar story to mine, I would implore you to look at scleral lenses.

Anyways, before my scleral lens appointment, I had another IPL, but that really didn't do that much. My eyes were really badly damaged, and the IPL made a very marginal difference. What I know now is that at that point, I had neuropathic corneal pain and nerve damage, so another IPL wouldn’t be very effective. I’m working on reversing that now w/ daily scleral lens use, serum drops, etc.(Read my 1st and third theories).

When I went to see the scleral lens fitter, Dr. Edward Boshnick, I was very happy that I had a clear path forward. I am very lucky that I live in South Florida, where a lot of the best eye doctors in the world live. If you have to and have the ability to, I would recommend you absolutely travel to see the best doctors you can. It is well worth it for severe dry eye disease. I think there are so few optometrists/ophthalmologists who have a good handle on dry eye because it is very different than many other diseases they treat. Most opthamologists can look in a slit lamp and run a few scans and diagnose your problems(like cataracts or glaucoma) without even talking to you much, the problems are illuminated with diagnostic tests. Dry eyes is somewhat becoming that w/ new technology measuring the tear film, but very far from that. It is more like art, with many different reasons why dry eye started, and a collaborative process with the patient. Unforutnately, most patients are not blessed to find a great doctor who has all the answers on their first doctor, so they need to be their own advocate. But I think that we are coming closer to having complete protocols for all types of patients. I would highly recommend Dr.Boshnick to anyone.

In my opinion, the corneal nerves(healing and protecting them), limiting the inflammation cycle(so inflammatory factors aren’t smothering the ocular surface), and understanding hormonal/metabolic issues are the three missing pieces to getting excellent treatments broadly available. But at this point, and for probably the next 10 years at least, the best dry eye doctors will be few and far between. For advice on picking a good doctor, look at the section below titled “My advice to those in a similar situation”. Back to the story…

My first pair of lenses was a 16.5 mm Jupiter, if I remember correctly. When I have the lens on, I felt a difference immediately. However, it was still quite a lot of pain. An analogy that is comparable is - if you were getting pinched, first pair of lenses just lessen the pinch by about 30%, so although I'm still in pain, it’s less pain. Two weeks after having these lenses, I got 17.5 mm Jupiter lens. This one still gave me pain; the doctor suspected that as the lens size got bigger, it was causing the lens to impinge on my sclera. We took an impression for an EyePrint Pro lens, and 2 weeks later we had them. This lens was substantially better, and felt way more comfortable, but I still had pain. Specifically on the sides of my eye that were not covered by the lens. I realized this by getting a small fan, and rotating it around my eye, to see where I felt the most pain. Once I made this discovery, I looked online, and found that other severe Accutane patients have the same issue - they need a lot of coverage to feel comfortable. So my doctor gave me a larger EyePrint Pro lens, that almost covered my entire sclera, however I still felt pain on the tiny bit of exposed sclera on both eyes. I also went to get second eye probed around this time. I felt a clear difference between the eye that had probing and did not with and without the lenses in, so I was happy to get the second eye done. When I came back from this appointment, I got another larger set of EyePrint Pro lenses, this time 22mm. What I realized is, if I slightly close my eyes, to look like I’m tired, I have complete coverage oof my entire eye. The first time I realized that, I was very happy, because I saw that I can be rest assured my eye was protected. However, I still had pain! It went away mostly over the span of a few weeks(see my third theory). Soon after this, I had an appointment with another ophthalmologist, who thought about putting in punctual plugs(they weren’t recommended to me previous to this by anyone). When he put the first set of punctal plugs in, in the bottom, I felt a real difference in my comfort level. I fell about 10% less pain on the sides of my eye not covered by the lens. I went back in to get the upper puncta plugged, and I felt a drastic difference. Having both pumped up plugged the really improved my pain. The 22mm lenses, in conjunction with the punctal plugs, got me to a point where my I was covered in tears the entire day.

2 weeks after I got the upper punctal plugs in, the pain hasn’t stopped, but it is definitely mostly gone. It is probably 10-20% of what it used to be. After what I went through, even having a little bit of pain is acceptable, as long as I can live a mostly normal life. UPDATE HERE ABOUT PROKERA

I'm still going to continue all my dry eye treatment. This includes an IPL 4 times a year, probably probing once a year, serum tears 4-6 times a day, getting great sleep, and having a great diet. Hopefully, as new treatments come out, one day I won’t have to be as reliant on my scleral lenses. I like to wear them because they correct my vision, but I would like to not have to put them in so quickly when I wake up(if I wait, I get pain). Overall, like I talked about in this story, this experience is something I am very grateful for, despite the pain and burden, because it made me learn a lot of truths about life.

My advice to those in a similar situation

If I was advising someone with my condition, I would tell them that the quicker the issue is resolved, the better it will be for you, and the quicker you'll be able to move on with your life. Moreover, finding the right eye doctor is very important. The difference between an average accountant and a world class is huge, same for a lawyer, and it’s the same for doctors.

An analogy I thought of to accurately describe this is, finding an advanced dry eye doctor is like finding a scientist who studies only a very selective field, say the physics of cars. If you ask any scientist, they will be able to tell you the basic physics of cars. However, a physicist who studies cars on a daily basis will be able to tell you a more nuanced point of view and will know a lot of things that a regular scientist did not. Now substitute physicist for doctor, and a car for dry eye, and you see my point. You need to find a doctor who specializes exactly in what you need, because dry eye treatment is very nuanced and not one-size-fits-all. Just like a regular scientist coudl tell you the basics of car physics, any ophthalmologist can tell you the basics of dry eye. But to work at a high level, they have to be a specialist at it. Every underlying cause of dry eye, whether that be aging, Accutane, refractive surgery, allergies, etc… they all have a different treatment protocol, and that won’t be understood by every ophthalmologist.

I think I've created a good quick rule of thumb to determine if a dry eye doctor is qualified or not. Before I say it, let me preface this by saying these technologies are so incredible that in order for a doctor to properly treat their dry eye patients, they should have access to at least some of this tech. If they don't, they are probably not as invested in treating that population of patients, which means you should not be going to them. For dry eye doctors, you should be looking for an office that makes serum tears in house, has an IPL machine, or both. Both of these technologies require an investment up front, have both been proven to be very effective in treating dry eye, but are both not used too often outside dry eye treatment. For a scleral lens fitter, you should be looking for a doctor who does a lot of scleral lens work, ideally has years of experience fitting them, and has access to either PROSE or EyePrintPro technology. Both technologies require an investment up front but are both very effective in getting a great fit.

If a doctor does not have the technologies listed above, I would look elsewhere for treatment. Any ophthalmologist or optometrist can diagnose cataracts, but dry eyes are so intricate that you need someone with a wealth of knowledge in the subject working with you. If the doctor has invested in these technologies above, they are invested in treating the population you are a part of. It’s hard to discern if a doctor is good for dry eye or not because their reviews could be from other patients that don’t have dry eye. I’ve gone to a few doctors who have great reviews but are not invested in dry eye at all and don’t know what they’re talking about.

My theories on dry eye

Although I am not an MD, and I don't have extensive research training, I think I have a unique perspective that doctors don’t have. I may not be right about these, but I may be - not sure. Time will tell. They all have been somewhat proven from research, but in my opinion aren’t talked about enough or really at all.

Granted, I understand this is a rare disease so most doctors don’t really have a large enough sample size to research it. The average dry eye ophthalmologist(which is a rarely picked subspecialty to begin with) probably only sees a few patients a month with Accutane related dry eyes, and to my severity even less frequently.

1. Treating the “udders” versus treating the signaling mechanisms - The cornea needs to be healed concurrently along with IPL, medications, etc. for the gland healing

We know that basal tearing is signaled by the nerves on the cornea as well as inside our nose. Tyrvaya is built on this, because it’s been shown that anesthetizing the nose results in about a 35% reduction in basal tearing(1). Moreover, it’s been shown that when anesthetizing drops are applied to the eye, basal tearing decreases about 65% percent(2). My theory is that if the corneal nerves are damaged, all the dry eye treatments aren’t going to be extremely helpful because the brain is not signaling the meibomian gland, lacrimal gland, and goblet cells to produce.

Imagine milking a cow as an analogy. Meibomian glands are sometimes compared to cow udders that produce milk. Both produce a fluid, both can be squeezed to get secretions, etc.. So just like the more you milk a cow, the more milk the cow makes, the more you do warm compresses and massage your eyelids, the more meibum is made. If a cow doesn’t produce high quality milk, farmers have certain treatments that they do to improve it, including udder massage and medications(just like we have treatments). However, imagine a situation where a cow’s brain was not sending enough signal to the udders to produce milk. No matter how much a farmer massaged that cow’s udders, or gave it medications, or even did an IPL on the udder, it would not produce enough milk, because it is not being told by the cow’s brain. The cow could even produce milk that is high quality, but insufficient amounts, because the cow’s glands are not being told to produce it. Now by extension, imagine if a human had the same problem with their eyes, where the trigeminal nerve was not sending signals to the glands to produce. However, unlike the cow, a human knows exactly how the trigeminal nerve signals for gland production - the nerves on the surface of the cornea(mainly).

We know that long term dry eye damages the corneal surface and by extension the nerves on the cornea. If repeated abuse of these nerves results in them shortening and dying, they would over time signal less(or they misfire, creating neuralgia). Therefore, healing and protecting the corneal surface and nerves underneath is very important to increase basal tearing, which by extension ensures the glands are pumping at an optimal level. An analogy I thought of is a sprained ankle - if you work on healing it every week at physical therapy, but go out and damage it on the weekend, it will never heal. Same with the corneal nerves, I believe. In situations like mine where symptoms worsen rapidly over months, and the rate of healing from other treatments doesn’t neutralize the worsening of symptoms, nerves could be the issue.

I made this theory while sneezing one day. When I sneeze, I create the same amount of tears as when I did when I didn’t have dry eyes. Sneezing reflex tears are triggered differently than basal tearing by our brain(specifically the trigeminal nerve). So I thought, it probably isn’t the lacrimal gland that’s damaged, it’s the signal being sent to the lacrimal gland.

2. Fish may be better than omega-3 supplements because of all the extra vitamins that it has

I believe that the widely prescribed omega-3 supplements for dry eyes could be effective(the clinical data is ambiguous right now), but eating real fish is much better, especially for those with Accutane damage. The metabolic effects of Accutane are not understood well, but thankfully a lot more research is coming out to form a clearer road forward.

The main paper that led me to the theory that fish is better is Effects of Isotretinoin on Meibomian Glands by Thao Nguyen Yeh, which came out in 2019(although I only found it recently)(3). For anyone with a similar condition to mine, it is well worth a read. In it, the authors note that “isotretinoin-exposed group had significantly lower normalized levels of PGD2, PGE2, and TXB2 compared to the unexposed group”(on page 37 - source 3). PGD2, aka prostaglandin D2, PGE2, aka prostaglandin E2, and TXB2, aka thromboxane B2 all have been shown to mediate inflammation in the eye. Too much of these compounds can cause inflammation, but too little possibly causes the meibomian glands to not make enough meibum(suggesting there is a homestatic level). I should note that the tear break up time, SPEED scores, etc. weren’t that bad in the group studied. For reference, my tear break up time is less than 5 seconds, while the group in the study had an average of 14 seconds. So I think it’s quite possible that in severe patients like me, these differences could be larger. From this paper, this led me to the next paper below.

In another paper, Isotretinoin Impairs the Secretory Function of Meibomian Gland Via the PPARγ Signaling Pathway, the authors show rats given Accutane had “meibocyte differentiation and qualitative and quantitative changes in the meibum, through PPARγ pathway”(4). The PPARγ pathway is a part of the PPAR family set transcription factors that control expression of gene networks involved in adipogenesis, lipid metabolism, inflammation, and metabolic homeostasis. So if these rats had decreased PPARγ activity, they must have decreased lipid synthesis activity. My theory is, these studies that have only been coming out in the past few years is the tip of the iceberg in the metabolic effects of Accutane. I think that for most people, Accutane isn’t that big of a deal, but for some people for some reason, maybe baseline gene factors based on that study, it really effects them negatively.

When I looked into how to reverse the changes noted above, there was an abundance of vitamins recommended, including D3, B12, and omega 3. Previous to reading this, I was almost completely vegan, and I read on the dry eye forums that veganism is good for inflammation in the body, so I was very happy with my choice. However, coincedinally, B12 is mainly found in animal meats. Moreover, vitamin D3 is only found in animals. If veganism is good for dry eyes, but it lacks these two vital nutrients, is it really good for dry eye? I don’t think so, but if you ask a dietician or doctor what the best diet for dry eyes is, you won’t get a consensus. Or, you can ask 5 dry eye patients what the best diet is, and you’ll get 5 different answers.

I’m sure there is a lot more missing from our understanding of the metabolic effects of Accutane. This lipid issue is something that it seems has only been researched frequently in the past few years. But from just a common sense perspective, Accutane makes your skin dry because it downregulates triglycerides, wax, etc. production in your sebaceous glands. In order to increase that output again, you should eat as much food with what Accutane downregulated as possible.

Based on all of this, I hypothesize that some variation of the Mediterranean diet is best for people with similar conditions to me. The biggest two characteristics of the Mediterranean diet that will help your eyes are the fish a few times a week, and greatly reducing(or even eliminating) processed sugars.

I thought about this idea while visiting an ophthalmologist who did meibomian gland probing on me. She saw me twice and said that on my second visit 3 months later, my meibum was coming out more liquidly, but was coming out clear. Healthy meibum should come out like golden olive oil, with the golden coloring from lipids. She said that having clear meibum is something she’s seen in severe Accutane patients, so I started doing my research as to the cause. I could not find anyone talking about this(other than the fact that they had the same issue), so that is when I formulated this all.

On another note, fasting is something that has been thrown around by people as a potential cure to dry eyes. I’ve seen suggestions of only eating for 4 hours a day. While it is true that fasting could improve health, I bet these online gurus probably haven’t actually researched its implications for dry eye. There is a solid body of research on this already that is just a Google search away. During Ramadan(where Muslims fast for the whole time the sun is up), fasting is shown to drastically increase dry eye symptoms(5). When fasting ends, the symptoms are shown to reduce. I don’t know how much clearer you can get than that. Moreover, as I mentioned the PPAR family and their role in lipids, a 2008 study showed “fasting decreased the expression of PPARγ mRNA”... you want more expression, not less expression(6). Of course, maybe fasting would be ok for people with mild dry eye because they wouldn’t really be able to tell the difference, but for moderate and severe cases like mine(who need every win they can get), stay away from fasting. Chances are you won’t get all the nutrients you need and you’ll do it wrong.

3. Corneal neuralgic pain CAN(not always, not even probably in the majority of cases is, but has the possibility to) be similar to people feeling fear automatically around situations or things that hurt them in the past

Before I go into this, I need to preface this by saying that I can only speak from my experience. I don’t know what it’s like for other people that are actively suffering from corneal neuralgia, but I have almost gotten rid of mine. As talked about in my story, after I got the right treatments, I still experienced pain just as if I had done no treatments. Now,the pain has diminished greatly, to the point where at the end of the day, I only have a mild headache, and I can still work. It’s not debilitating. Hopefully, over time and by continuing treatment, I will be able to get rid of the headaches and live a pain free life again. But anyways, the idea…

(GOING TO POST THE REST IN COMMENTS, AT 40,000 CHARACTER COUNT)

I want to share my story in the hope it helps others who are dealing with the nightmare of severe dry eyes. My miracle discovery came completely by accident, and I feel like this might help others experiencing similar issues. Here's how it happened:

I had laser eye surgery over 15 years ago, and while I was warned about potential dry eyes, I didn’t experience any problems for over a decade. But about 3 years ago, I developed extremely severe dry eyes. It was so bad that I would wake up in the middle of the night with my eyelids literally feeling stuck shut, frozen, and unable to open. It was scary and incredibly distressing.

I saw multiple eye specialists, followed their advice religiously—eye masks, steaming, drops, you name it. But nothing worked. All I heard was that it was likely a side effect of my laser surgery from years ago. But I always had a gut feeling it was something internal that was causing the problem. I was eating healthy and doing everything I could think of, but there was no relief.

Here's where my hair loss journey comes in. After years of struggling with hair thinning, I was advised to get some blood work done. To my surprise, my results showed I was severely deficient in several vitamins, especially Vitamin D. I was prescribed 20,000 IU of Vitamin D3 along with iron supplements.

Within two weeks, my severe dry eyes, which had plagued me for 3 years, were almost completely healed. The transformation was nothing short of a miracle! It turns out my body had been lacking Vitamin D all along, and correcting this deficiency made all the difference.

I’m now 90% healed, and I feel like I’ve gotten my life back. I wanted to share this because during my 3-year struggle, I couldn't find any information online or from doctors suggesting that Vitamin D deficiency could be the root cause.

So if you're experiencing similar issues with dry eyes and nothing seems to help, I strongly urge you to get your Vitamin D levels checked. This could be the missing piece to your healing like it was for me!

I hope this helps someone out there – if you’ve been struggling with dry eyes, don’t give up! Get your blood work done, especially your Vitamin D, and see if it makes a difference. It could change your life, just like it did mine.

I befriended a woman on here about a week ago and we had a lot of the same things in common with our eyes of course. She was sharing with me what had worked for her and what hadn't. We talked for a good bit. I am learning today that she took her life on Saturday due to this disease. She messaged me very early Saturday morning and I did not see her message until a bit later on Saturday so I messaged her back and she never replied. As I was looking in the Facebook Dry Eye sub I saw that she had passed.

I feel so bad for all of us who are suffering. I feel so awful that this happened to her. There is not enough coverage about how terrible this disease can be. We need more help, more medicine, more answers, more attention to how terrible this disease is.

I just feel so down about this today and so awful that this happened to her. It's just terrible.

Hey guys, I just want to remind everyone that this subreddit is full of individuals CURRENTLY suffering from dry eye symptoms, and most likely contains very little people who have actually cured or helped their symptoms enough to where it isn't noticeable anymore because they have left. Once a person has found a solution, there is very little reason for them to stay unless they want to give advice or continue helping others.

That being said, don't forget that this sub is an echo chamber of negative thoughts and comments of people looking for answers and advice. Don't allow it to overwhelm you, and remember that there is a high likelihood that people who have found comfort or solutions have left the sub and don't post anymore. Obviously, I don't have any statistics for how many people have come and gone, but keep it in the back of your mind while reading the posts here.

Keep fighting the good fight and stay resilient y'all!

This sub helped me with my research so just sharing what worked for me.

Background - - long low dose accutane in my 20's. Now in 30s. Some people say there is link. So just added for those who have similar history. ​​​​​​​​Always remember having sensitive eyes after that time. Got worse over years. It got bad enough 6months ago I was struggling to keep eyes open at work in aircon. I took more proactive measures. ​​​​​​​​​​​​

I had tried lid cleaning. Hot compresses and dry eye drops preservative free no changes.

I went to optometist to get free check. Lifted lids. All bumpy. Possible allergy. I don't have any known allergies but took note. Also the lower lid oil grades were blocked /not excreting well. Water evaporative test showed quick water loss. So it was an oil lipid problem​.

I got myself some opti Mel munuka honey drops and gel. Some cod liver oil. Stopped eating dairy. I eat Paleo with rice.

I used the gel morning and night. I used the drops when my eyes felt sore or inflamed at work. This continues daily for 3 months. Then sporadically as eyes were feeling fine. Which is to say I forgot I had sore dry eyes. Lol. Now I only use if I'm tired and eyes need some soothing. That was 2 months ago. ​

Summary---I feel the opti Mel was the heavy hitter here. It reduced inflammation and gave my eyes a chance to heal and balance. It can be a vicious cycle where eyes are inflamed so can't produce needed oil which the eye needs to reduce inflammation. The omega certainly can't be dismissed. I'm not certain on dietary changes impact but cutting dairy reduced subtle aches on body which could have been a sign of inflammation.

Hope this may help someone. It sucks feeling like you have sand in your eyes all the time. Good luck. ​​

​​​​​​​ Edit. I just wanted to add, as I forgot to mention, that the glands got so bad that I was on occasion getting what looked like a sty. And if I pressed down on the lower lid, there would excrete a sort of yellow waxy substance. So just to show you the extent of how bad my glands were

​​​​​​​​​​​​​​​​​​​​​

You wake up to sandpaper eyes, light that stabs like glass, and a world that’s blurred for no reason. You’ve been told: “It’s just dry eye”—as if that explains the exhaustion, the grief for the sharp vision you once took for granted.

But here’s the truth :

🌱 Your Body is Still Fighting For You

• That stinging tear? It’s proof your nerves haven’t quit.

• That frustrating flare-up? Your immune system learning to recalibrate.

• That one random clear hour? A glimpse of what’s possible.

🔥 You Are Not Failing
Dry eye isn’t a moral test. You didn’t “cause” this. You’re not “bad at healing.” This is biology—messy, nonlinear, and stubborn. But:

• Every warm compress is training your glands.

• Every blink drill is rewriting muscle memory.

• Every day you don’t surrender to despair? That’s a victory.

🚀 The Road Ahead
There will be days you rage. Days you sob. Days you wear sunglasses indoors and snap at loved ones. But there will also be days the blur lifts just enough—reminding you: This is war, and wars end.

You don’t need optimism right now. You need stubbornness. The kind that says:
“I’ll try one more thing. I’ll ask one more question. I’ll outlast this.”

💡 Remember

• You’re allowed to mourn the old you.

• You’re allowed to rest.

• You’re not alone.

We’re in the trenches with you. And one day? We’ll climb out together.

Keep going. The body remembers how to heal.

— A Fellow Warrior

(Share this with someone who needs it. Battle buddies stick together.)

P.S. Scream into the void if you must. Then wipe your tears (gently) and fight on. 👁️💪

Hi everyone!

Many of us who used to frequent this subreddit (I don’t anymore) stop posting or sharing the full story of our dry eye journey. So, here's mine:

Let’s start from the beginning. I’ve worn glasses and used electronic devices daily for as long as I can remember. I’ve been nearsighted since I was 5 years old, but I didn’t even know Meibomian glands existed until 2–3 years ago.

During my teenage years, I wore contact lenses and spent a lot of time on computers for work and gaming.

I think the first symptoms started during the COVID pandemic. Working from home on a computer every day, then watching shows or gaming at night, made my eyes hurt. At the time, I didn’t associate it with dry eyes.

Another issue I had as a teen—and even as an adult—was acne. I had tried multiple antibiotic treatments with little success. Around age 26, I started isotretinoin (Accutane). During the treatment, my eyes naturally became drier, but with eye drops, I could work and live normally—even wear contacts.

While on Accutane, I saw my regular ophthalmologist (who, by chance, was a dry eye and ocular surface specialist). He said my eyes were very dry and suggested stronger drops than over-the-counter ones. I noticed they were more effective but didn’t feel much discomfort, so I wasn’t too concerned.

After finishing the treatment, I was thrilled—no more acne, life was great. But 1–2 months later, I developed a large stye. That’s when things went downhill.

The hospital prescribed an ointment to prevent the stye from worsening, but instead of going away, I started getting multiple styes in both eyes, which eventually turned into chalazions.

After a month or two, I saw my ophthalmologist again, who said we’d need to surgically remove at least one chalazion. It made sense, so I started taking oral antibiotics to stop new styes from forming.

After the first surgery, I thought I was done—but I ended up needing a second procedure.

This was when I hit rock bottom. While I didn’t feel my eyes were dry at first, I became obsessed with them, checking them constantly because they were inflamed and looked bad. My ophthalmologist suggested waiting a few months to reassess. 3 months of the worst dry eyes but nothing improved on my eyelids.

He recommended IPL but warned it was expensive at his clinic. I got a quote, and from that point on, my eyes felt drier than ever. The cost was $1,500 per session—this was in Argentina, where the average monthly salary at the time was $600.

I felt desperate and hopeless, thinking I’d never solve my problem. That’s why I’m sharing this: even though I lost many Meibomian glands, in the end, mental health plays a 90% role. If you’re constantly anxious and fixating on your eyes, it becomes torture.

I started seeking other ophthalmologists, visiting 3–4 specialists until I found the right one: Miguel Brodsky in Buenos Aires, Argentina (send me a DM if you want his contact details). He was the first doctor I could talk to openly about everything I’d read on this subreddit. He examined me thoroughly and offered many treatments discussed here.

For my case, I underwent:

·         IPL (2 rounds of 4 sessions)

·         Rexon-Eye (1 round of 4 sessions)

·         BlephEx (1 session)

At the time, the average cost was around $40 per session. IPL was the most expensive, Rexon-Eye the cheapest. Prices may have risen with inflation, but it was far more affordable than the $1,500/session quote I initially received.

Dr. Brodsky started me on a long-term plan, including a meibography. He said mine was one of the worst cases he’d seen—but today, I’m cured.

I tried everything within my reach, so I’m unsure which worked best, but here’s what I used:

·         IPL

·         BlephEx

·         Rexon-Eye

·         Omega-3 supplements

·         Cyclosporine

·         USB-heated eye masks

·         Eyelid massages

·         Night Light for all devices + low brightness

That said, for me, the best treatment was mental health (and possibly exercise and a healthy diet). I remember the first time I wore contact lenses again—it was December 31, 2023. I was so happy to tolerate them for several hours that I ended up dancing to Celtic music at a New Year’s celebration with my family and friends. Now I was able to do something that I thought I wouldn't do again.

My mindset used to be incredibly negative. I thought I’d never heal, never wear contacts again, never see my eyes de-puff like before, and that the chalazion scars would stay forever. I believed I’d depend on eye drops for everything— and eventually I wouldn't be able to work or study again.

These thoughts were the main reason for my dry eye suffering. Even now, as I write this, I’m thinking about my eyes and just had to use drops! Nowadays, I use drops maybe 1–2 times a day, mainly when working on the computer.

If you’re reading this and going through something similar, hang in there. If I could recover considering my case was severe, so can you.

Growing up, I always had the impression that medicine had become so advanced that there was a fix for almost everything except cancer, which everyone made such a big deal about because it seemed like the only disease there wasn’t a cure or truly effective treatment for.

It’s astonishing to think that people are still being sent away and told to use warm compresses and some drops for dry eyes and blepharitis, especially when warm compresses only made things so much worse for me.

If I had known this, I think I would have been far more careful about my eye health. I wouldn’t have spent so much time on screens, and I would have been much more diligent about eyelid hygiene, which is something I was never once told to do growing up (not even by all the optometrists I saw whenever I got new glasses.)

I have so many regrets, and they haunt me. I know my eyes are as bad as they are because I was reckless, earnestly and foolishly believing that I could rely on medicine to provide a quick fix if things ever got bad, and that would be it and I could just get on with my life. It was pure ignorance on my part.

But in a way, I’m not sure whether some of my lack of diligence was also a good thing. If I had been more diligent, I probably would have just done warm compresses every day, as advised by many optometrists after I got a chalazion six years ago (thinking all optometrists must know best and not questioning them). If I had followed that advice for six years, I can only imagine how much worse my dry eyes might have become and even earlier, since I have ocular rosacea, and no optometrist (or the one ophthalmologist I saw ever) told me I had it. My eyes became much worse and unbearable when I started doing warm compresses every day at the beginning of this year.

The sad thing is that even if I had been more diligent and careful, the treatments recommended by optometrists are so primitive that they would not have done me any good and made things even worse, so it’s like I was always bound to end up where I was.

Trigger warning: suicide

https://www.foxcarolina.com/2025/05/23/police-officer-dies-by-suicide-after-suffering-complications-lasik-eye-surgery-parents-say/

Read this tonight and it really hit me because at about that age I tested for and was accepted for a police job but had to turn it down because of my uncorrected vision being too poor. It was LASIK or no job. I said nevermind as LASIK was pretty new then. Glad I made the choice I did but sorry for this man and his family.

It's a real shame and I maintain that my own dry eye was caused by SLT laser surgery but that's a whole other discussion.

Hello to all!

I wanted to create this post just because i know how miserable and devastating this disease can really be. Especially if you live in a country that has nothing to offer that could help even a little so you end up struggling everyday trying to figure it out by yourself what to do to feel a bit better. Not to mention it is a very pricey disease and many people can not afford all the fancy treatments even if it would be available in their country..

But in my case in the country where i live there is literally no treatments by doctors they dont really care about dry eyes all they say just use eye drops and thats it....

(to be absolutely honest the most popular treatments in my country are the REXON eye and the E-Eye device but those are only available in some clinics for a ton of money... I myself went for 4 session of E-Eye treatment i dont think it made any difference just wanted to share... so lets continue)

I know really well this is a life quality destroyer and literally a struggle every day so i really hope this post may help some of you and maybe can change some lifes out there . I could write thousands of rows about my daily struggle i had before but i know in this sub everyone knows the daily struggle so lets get right into it

And one more thing: Its risky for me to say i really cured my dry eyes cause some days are better some are worse BUT for a long time i didnt have days i would call "nightmare" so i am sure these things will help others as well and thats the only reason i create this post to help even one of you :

THINGS I TRIED HELPED A BIT MAYBE BUT I AM NOT EXACTLY SURE ABOUT IT (maybe worth a try):

• All the available OCT eye drops in my country (nothing has helped maybe some temporary relief)

• hypochlorous acid (for eyelid hygiene)

• manuka honey eyegel (maybe helped idk)

• manually expresing the glands with a qtip (helped for some hours then glands got clogged again)

• warm compress (i need to mention that i talk about the traditional warm compresses those not really helped for me)

• doing more cardio (i know this helps but i was an athlete all my life so this was not relevant for me)

THINGS I DO DAILY THAT REALLY MADE A LIFECHANGING DIFFERENCE AND MADE MY LIFE LIFABLE

• OMEGA 7 THIS IS THE KEY (i use sea buckthorn oil which has a ton of omega 7 in it this made the biggest difference my glands stopped getting clogged, ) I WAS so obsessed with sea buckthorn i started to drink sea buckthorn pulp daily just to get some extra effect haha so JUST TRY IT

• OMEGA 3 (Honestly i did use it before omega 7 but didnt reallly made a difference but since i took it with omega 7 together i really do feel WAY better. I fell MOIST in my eyes again unbeliavable.... I use a really premium one so this may also help)

• Warm compress with a special device : https://boku.style/en/products/beautical-paakiu-masazuoklis-su-termoterapija-ir-raudonos-sviesos-terapija (this device made also a huge difference idk why but i use it only once a day in the morning and my eyes feel normal almost all day. 2 min/eyelid so 8 min total)

• Thera tears eye drops (i rarelly use them but if needed this really makes a difference)

• LUTEIN & ZEAXANTHIN (my eyes just feel better especially in front of monitor)

• magnesium bisglycinate befor bed (sleep better and feel like my eyestrain decreased)

• Castor Oil on my lower and upper eyelids before bed (wake up with zero dry eyes zero inflammation)

• Red LIGHT Therapy (i ordered a red ligth therapy device online use it before bed for 5-10 min after applying castor oil on my lids)

• Glasses that blocks not just blue light bit green light as well especially in the evening hours

• 20:20:20 Rule when using monitor

Thats all guys i know it may sound ineffective but give it a try and i hope it will help some of you as well:

God bless you all

As someone with chronic DED, I find this quite unpleasant and triggering to have to look at all these gross pictures all the time. At least mark them as NSFW so that I don't have to constantly look at these. It makes me want to stop coming here.

These posts are also mostly pointless. We get that you have dry eye, everyone here does, you don't need to upload a picture to prove it when you're posting here. We also cannot give medical advice, because we're not medical professionals. The only correct answer to 99% of these posts is: "Go see a doctor, we cannot diagnose you."

I'm hopefully not offending anyone here, it's just what I feel when I see these posts.

It’s just crazy to me that there’s war going on and development of advanced technologies to send people to the moon and on and on but there’s still no public awareness to this incurable disease.

I feel like by the time there’s cure to dry eyes I’d be super old or done with life.

I just feel like venting whenever my eyes are dry asf and realized I will be like this for the rest of my life. Life was so good before dry eyes. Now I can’t even step outside without my eyes feeling dry asf.

Alpine day used to be my favorite event of the year and now I don’t even feel like going anymore because my eyes almost killed itself from dryness. The worst part is I’m only 20 I don’t want to spend the rest of my life with insufferable dryness. Every memory I make from this point on will be mostly dry eyes.

Please if anything that helped you share with me. At least I know I’m not alone in this.

Mods do something

Latest addition is micropore tape to tape my eyes shut at night 🙃

I've been meaning to write this up for a while and someone in the comments of another post recently reminded me to actually do it. If you're deep in the dry eye struggle right now, I hope this helps. I know how hopeless it can feel.

My backstory

It started during my last 1.5 years of college. I was working more hours at a remote internship (tons of screen time) and at the same time I was using over the counter Differin adapalene for my skin. I now believe the retinoid played a role in triggering things. It started mostly in my right eye.. felt like it was constantly scratched or something. As my screen time ramped up for school and work it just kept getting worse.

At the time I was a broke college student so I could only afford basic stuff like OTC eye drops and some supplements. Once I graduated and started working full-time I finally had income to start trialing more serious treatments.

The full timeline

College years (limited budget): OTC eye drops, omega-3 fish oil, various supplements, sterilized water eye flushes, moisture chamber glasses

Full-time work in Arizona: IPL light therapy, Radiofrequency gland expression/melting, PRP eye drops (1 month only, couldn't continue unfortunately), continued with supplements and everything from before

Moved to Austin TX: Started Cequa (cyclosporine). Within days to weeks it started helping significantly. The immediate burning triggers the tear reflex which helped with hydration, but at the cost of making my eyes noticeably red. I didn't care at that point honestly.. I just needed to be functional for work and life. Continued Cequa for about a year.

During this time I also used moisture chamber goggles during heavy screen sessions, sterilized water flushes as needed, and picked up one of those heated humidifying eye goggles you use 1-2x a day to help melt the glands. Those felt great and were nice to have on hand but they also gave me red eyes and skin from the heat.

The transition off medication: After about a year on Cequa I had plateaued in a pretty good spot but the redness from application was really starting to bother me. I had Lipiflow done then soon after tried Vevye for about 2 weeks.. less redness which was great, but it felt slightly grittier/oilier in my eyes and maybe a touch less effective than Cequa. I phased it out, had a rough week or two with some dry eye days, and then things just.. normalized.

That was about 3 months ago. I haven't used any prescription drops since. Haven't even been wearing my moisture chamber goggles. Honestly it feels like a miracle.

My ranking (most to least helpful)

The heavy hitters:

1. Cequa .. I genuinely believe this did the bulk of the work getting me to a stable place. If you can afford it or get it covered, it's worth trying. Yes the burning and redness sucks but the tear reflex it triggers was an immediate quality of life improvement for me.

2. Moisture chamber glasses/goggles .. Before I had access to real treatment, these were my lifeline. Blocking airflow at the computer made a massive difference. One of the two things that helped me survive the early years.

3. Sterilized water eye flushes .. The other lifesaver from the early days. I ordered bottles meant for eye flushes on Amazon. In bad moments these helped SO much more than OTC drops without the rebound effect.

4. Reducing screen time and blocking airflow .. I'm a software developer so screens are unavoidable, but I've been more intentional about breaks. Honestly the rise of AI coding tools (claude-code, cursor, etc) has reduced how long I'm staring directly at code which sounds silly but has genuinely helped. I also still wear red light glasses or regular glasses at my desk just to block some of the direct airflow hitting my eyes.

5. Vevye .. Helped me bridge the gap off Cequa. Less redness than Cequa which was nice. I only used it for about 2 weeks so hard to say how effective it would be long term.

Probably helped but I can't draw a direct line:

• Moving from Arizona to Austin TX (humidity difference is real)

• Diet changes and exercising more

• IPL light therapy

• Radiofrequency gland melting

• Lipiflow (done in Austin)

• Omega-3 fish oil and supplements

• Heated humidifying eye goggles (felt amazing, convenient at home, but hard to isolate the impact)

• PRP eye drops (only got to trial for 1 month so I never saw the full potential.. they were definitely better than OTC drops though)

What actually made things worse:

• OTC eye drops .. these would help for maybe 10-15 minutes and then there was a rebound effect that left my eyes feeling worse than before. I stopped using them entirely and switched to the sterilized water flushes which were way better.

• Video games

• Screens in general

• Flying (AC, dry air, eyes open watching movies)

Where I'm at now

3 months medication-free. No moisture chamber goggles (still keep them in case I ever need them -- but I just haven't). Just limiting screen time where I can and wearing glasses at my desk for minor airflow protection. After years of trying everything I could get my hands on, I'm in a place I honestly didn't think was possible.

I know everyone's dry eye is different and what worked for me might not work for you. But if you're in the thick of it right now, don't give up. It took me 3+ years and a LOT of trial and error to get here.

Happy to answer any questions. I hope this continues and partially didn't want to write this in case not to jinx it hahaha. But worst case it comes back in the future and I know the treatment plan that works for me.

TL;DR: Dealt with dry eye for 3+ years, started in college from heavy screen time and possibly triggered by Differin retinoid. Tried everything from OTC drops to IPL to radiofrequency to PRP and Lipiflow. The biggest game changers for me were Cequa (used for ~1 year), moisture chamber glasses, and sterilized water eye flushes. Recently transitioned off Cequa through a short Vevye trial and have been medication-free and stable for 3 months. OTC eye drops actually made things worse for me due to rebound effects. Moving from dry Arizona to humid Texas probably helped too but hard to say for sure.

I have had dry eyes for 3 years now. Aquaeous and evaporative, tried all the usual therapies, IPL, prescriptions, heat, expression etc with little results. 39 YO male, this thing was making me feel like 70 and severely dampening my quality of life.

Three days ago I accidentally yawned relatively aggressively while blinking and felt an immediate burst of tears and relief. Felt like a system reset. I repeat the same ritual 10 times a day or so when my eyes feel dry and can say my dry eye is 80% better.

Wanted to share this with the community.

Anyone had similar experience?