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Can I do TransPRK if I have dry eyes due to Meibomian Gland Dysfunction?

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Eye & LASIK

Hi doctors,

Due to contact lense overwear, I think I have mild meibomian gland dysfunction and dry eyes. Half of my left eye’s upper inner eyelid is slightly red and swollen, and my eyes can’t tolerate contacts anymore. However, without contacts, my eyes aren’t dry or painful.

Would like to ask if TransPRK or PRK will be suitable to me? I understand bandage lenses will be worn for days and I’m afraid they will make my blocked glands worse. Recently, I have stopped wearing contacts and started taking Omega 3, but I don’t see significant improvements. Thank you!

DOCTOR’S ANSWER (3)

Dear bh,

Yes you are right that meibomian gland disease (MGD) is a major cause of dry eyes. If you do have a combination of MGD and dry eyes, there are many ways to treat them!

However, since you mentioned that your eyes are neither dry nor painful without contact lens use, I suspect you may have another condition known as Giant Papillary Conjunctivitis (GPC).

It is very common for chronic contact lens over-wearers to develop GPC. It is your body’s response or ‘rejection’ to the chronic use of contact lenses, which is regarded as a ‘foreign’ material to your eye. Think about it, if we are putting a foreign object in our eyes for the most part of every day for 10-20 years, it is likely that our body will develop an ‘allergic’ response to it. Over time, the inner surface of your upper eyelids will become swollen with the appearance of giant ‘cobblestones’ (your eye doctor can elicit this under slit lamp examination).

Symptomatically, you will feel pain, itch or dryness each time you try to wear your contact lenses. And as you rightly mentioned, your eyes just cannot tolerate the contact lenses anymore.

You may treat this condition with anti-inflammatory eye drops until the episode has passed. However, going back to contact lens wear is tricky (the type of contact lens makes a difference) and may never be possible for some people.

In fact, patients with GPC are definite candidates for refractive eye surgery (after their eyes have had time to recover), because it is generally recommended that they should no longer use contact lenses forever. In which case, they would have to find an alternative long-term solution if they want to avoid spectacle use altogether.

My advice for you would be to have a consultation with your eye doctor, have your symptoms treated, be it from MGD, dry eyes or GPC, before deciding on which refractive surgery is best for you.

I hope this was helpful to you.

0 873 views 0 Doctors agree Wed Jan 24 2018 06:57:51 GMT+0000 (UTC)

Hi bh

The question about whether you are suitable for TransPRK, PRK, LASIK, or any other refractive surgery really depends on the severity of the dryness, and whether, if severe, it can be reversed. This assessment can only be done with a thorough consult and examination in clinic.

You may like to see my detailed answer here for dry eyes and LASIK.

You may also like to see my answer about chalazia and meibomian gland dysfunction (MGD) here.

I would advise you to see an eye doctor (ophthalmologist) with special interests in LASIK/refractive surgery and the front of the eye (anterior segment/cornea), to get a definitive diagnosis about your condition.

There are many ways to treat both dry eyes and MGD, and I am confident that with some of these methods (over and above Omega 3 oils), you will feel much better and possibly be able to have refractive surgery in future.

0 883 views 0 Doctors agree Wed Jan 24 2018 02:00:19 GMT+0000 (UTC)

Hi bh,

Indeed, the majority of dry eye cases caused by Meibomian Gland Dysfunction (MGD) are mild. Usually, this can be simply treated with lubricating eyedrops and are not a contraindication to laser vision correction, in particular, Advanced Surface Ablation (ASA) procedures such as TransPRK.

If you are contact lens intolerant, don’t like wearing glasses and you are looking to laser vision correction as a solution, no matter which procedure you choose – be it TransPRK or LASIK or ReLEx SMILE – you will need to do a thorough eye examination for the ophthalmologist to fully assess your eye condition first. 

TransPRK is a surface-based, no cut flap procedure that has the lowest risk of dry eye aggravation amongst all laser vision correction procedures.

The bandage lenses that you will be wearing right after the TransPRK procedure are not your normal soft contact lenses, but a special soft silicone high oxygen permeable hydrogel lens and is unlikely to make your blocked glands worse. The lenses are meant to be worn to serve as an “artificial flap” to protect the treated surface and will be removed by your doctor after four days.

I hope this was helpful.

0 872 views 0 Doctors agree Fri Jan 26 2018 11:39:13 GMT+0000 (UTC)
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