WWYD 26 y.o., 70% dropout, low Schirmer’s, Post-Accutane
Stats: 70% gland dropout on lower lid (and thick miebum), Schirmer’s 4 and 7, nerves and cornea healthy, OSDI around 10 when using allergy drops and glasses, around 35 before allergy drops and glasses
Using: Miebo, Blink Nutritears supplement, GelTears, PF drops, lid wipes, Pataday 0.7%, humidifier, prescription glasses to reduce eye strain
Considering: IPL, LipiFlow, autologous drops, anti-inflammatory drops, fish oil, moisture chamber goggles, punctal plugs, Tryptyr
I have been off Accutane for two years. I was stable, but flaring up a couple times a year. I now believe the “flare ups” were almost entirely allergies. I had never had them before, but I think with low Schrimer’s I may be more susceptible to them now.
Recently started a BAD flare up in February. OSDI 35, pretty much constant discomfort. In January I moved into a house in the woods, so worsening allergies could be due to extreme levels of tree pollen assaulting my eyes on a daily basis.
During this period, I was ready to try anything, IPL, LipiFlow, etc. but now that I’m stable I don’t know if I should still do it to slow progression, or if I should leave well enough alone.
I am receiving a trial of Tryptyr that I’m willing to try, but I’ve seen some pretty discouraging stories of people getting injured from IPL (and there aren’t a plethora of skilled dry eye specialists near me that I would trust to do it).
So my question is, in my position (low symptoms but bad stats), would you be aggressive in treatment or focus on management through the lowest-risk routes?