When a Doctor’s Advice Wrecks Your Routine and Leaves You Spinning
Information overload: that was the state of my mind after a new doctor gave me a new diagnosis and a new treatment plan. Much of the advice was opposite of what my previous doctor had advised, and it was like a bomb being dropped on everything I had been doing for my dry eye disease.
Getting another opinion
After months of committing my care to my first doctor, I had seen some progress, but my eyes still did not feel normal. I had trusted the process, but I felt like I now needed a second opinion. My original doctor diagnosed me with both aqueous deficient dry eye and corneal neuralgia. I was taking Xiidra twice a day and autologous serum tears four times a day, as well as using lubricating drops, warm compresses, a lid and lash cleanser, and hypochlorous acid spray.
However, I felt like a piece of the puzzle was missing. I felt like there could be a problem with the oily layer of my tear. My original doctor had assured me, after a scan of my meibomian glands, that they were not clogged and that my oil layer was good. I needed someone else to confirm or deny this.
I scheduled an appointment with one of the country’s most prominent dry eye doctors. After a lengthy examination, he concluded that I had meibomian gland dysfunction (the oil in my glands was toothpaste consistency), mild rosacea, and an overgrowth of demodex mites.
I said, “My other doctor diagnosed me with aqueous deficient dry eye.”
“That is not what I am seeing now,” replied this new doctor.
“What about the corneal neuralgia diagnosis?” I asked.
“Well, any time you have extended trauma to the eye, there will be some form of nerve damage. However, that is not your biggest problem.”
The doctor's recommendations
He went on to advise that I have four sessions of intense pulsed light (IPL). IPL can reduce inflammation, heat and break up hardened oil in the meibomian glands so that it can be expressed, kill demodex mites, and stimulate cell mitochondria to improve gland function.
He also compared the texture of my conjunctiva, the lining of my eye, to that of an old carpet that has been pulled up, due to the friction of my blinking. This conjunctival chalasis – fold in my conjunctiva – could require surgery.
He said that I should continue the Xiidra but stop regularly using the serum tears after the IPL treatment so that I do not wash away oil that is being produced. I should use them only as needed for dryness. Should I have any additional issues with my corneal nerves after the IPL, he would start me on platelet rich plasma drops, as they have 14 times the growth factors of serum tears.
Told to stop some of what I was doing
He also said to stop using warm compresses because, though they can help with oil secretions, they can contribute to inflammation. He also said to stop the lid scrubs, as scrubbing can cause inflammation. Instead, I should wash my eyes very gently using room-temperature water and follow up with a gentle wipe that he gave me, making sure my lids and lashes are free of debris.
I nodded, taking it all in. He also suggested that I read his book before my next visit and use an ancestry and health service like 23andMe to see if I had any genetic predisposition for inflammatory diseases.
Trying to take it all in
“How’s your diet?” he asked.
“I’ve been eating clean for several months now.”
“What did you eat for breakfast this morning?”
“Ground turkey, avocado toast, and berries.”
“Nope: no meat. Meat is inflammatory.”
“Eat fish, lots of fish. And no eggs. Eggs are inflammatory as well.”
“Okay,” I swallowed, trying to figure out how I could go without eating meat and still get enough protein.
Feeling overwhelmed and exhausted
After my IPL treatment but before I left that day, I asked his assistant to write down everything that he advised. When I left the office, I felt overwhelmed and exhausted. So much of what I had been doing my doctor was now advising against. And what meat-free meal was I going to eat for dinner that evening?
A few changes would be easy to make, but others were confusing and took a bit more work. Over the next few days, I decided to take some advice from one of my favorite podcasts, "The Next Right Thing" by Emily P. Freeman. Instead of worrying about every little decision that I was making, I would relax and give myself some grace and just do what I could do.
What was my next right thing?
I decided not to quit meat and eggs completely, but to reduce it while I did some additional research. I slowly began adding some vegan and pescatarian recipes to my diet while digging into the science behind it. I did some additional research on all of the diagnoses and treatments discussed in my visit. I gave myself time to process it all.
Has a doctor’s visit left you overwhelmed? How did you handle it? Share your experience below.
Which barrier below prevents you from receiving better chronic dry eye treatment? (Select all that apply)