Caring for Eyes
that Can't Take Care of Themselves
(indented text by AN patients)
Dry eye is a frequent post-surgery problem due to eye nerve damage, which occurs when the eye does not blink properly or when not enough tears are produced. Dry eye is one of the problems for ANers with facial paralysis, but it can also happen when the facial muscles are working properly. Studies show that long term eye discomfort and other eye problems affect at least half of AN surgery patients, particularly if the tumor was medium or large.
It is very important to make sure the cornea of the eye doesn't dry out, because that leads to ulceration of the cornea and attendant scarring, both of which are potentially vision-threatening. To ensure healthy vision, it is important to be under the care of an eye specialist:
If you experience facial paralysis, whether it's temporary or not, insist, do not ask, for a referral to an ophthalmologist. Immediately. In the hospital if necessary. This is extremely important. My surgeons merely told me to "keep your eye moist until your eyelid starts working. Tape your eye shut if you have to. Put some drops in your eye during the day." This advice, while technically correct, was apparently not delivered with all of the emphasis it should have had, because I began to experience eye discomfort, and went to an eye doctor. He told me that he sees on average two or three patients a month who have moderate to severe problems with "dry eye" after AN removal. Also, the ophthalmologist has special equipment which allows him to scan the surface of your cornea to see what if any damage has already been done.
There are several ways to keep the eye moist. Below is a discussion of some of them.
- add moisture (artificial tears) to counteract natural evaporation;
- put a gold weight in the eye
- patch or tape the eye if the tears are not enough;
- keep the eye safe at night (by using a plastic bubble or Saran Wrap);
- plug or seal the tear ducts to allow for tear build-up;
- use special contact lenses or special glasses to keep in moisture and to protect the eye;
- surgical procedures to help the eye blink, or to reduce its exposure to the drying air.
Note that not all dry eye problems in AN patients are due to the AN itself:
I am a wait-and-watcher with a small AN and an opthamologist assigned my dry eye to the AN. Believing this is nonsense (little data for such a small AN to have such an impact) I went to a neuro opthamologist. Turns out none of this was due to the AN. I had an another rare condition called silent sinus syndrome where the floor of the eye was falling in due to chronic sinus conditions. I had surgery to repair it and the dry eye is gone.
Artificial tears to avoid real ones
While everyone agrees that eye lubrication products help, there is disagreement about the exact brand:
I've got total facial paralysis and minimal to zero tear production. I did have repeated eye infections, twice in the affected eye and once in the other eye. This was because I was not told how to properly care for or tape the eye. The eye never closed (first 5 weeks) and partially closed thereafter. I eventually was prescribed 7 different eye medications before Celluvisc from Allergan solved the problem. It's a little thicker and preservative free, my endorsement goes 100% behind it. I've tried them all and this is the only stuff I'll use.
The Refresh family of lubricants (Refresh, Refresh Plus, and Refresh Tears) are a great, but they do not work for all types of dry eye. Celluvisc is much more viscous than Refresh and it has a little more "staying power", although some users complain of a blur while using Celluvisc.
I, also, used all types of eye lubrication to try to find relief. The only thing that would come close to providing some relief was the gel. When I used Genteal, Celluvisc and others, I would find myself putting the medicine in several times within a half hour time span.
I've tried them all, and what works best for severe dry eye is BION TEARS by ALCON. I'm 18 months post op and my eyes are still perfect with no redness or scratches. I also wear special sunglasses that mold good to my face and keep out the breeze.
Patching or taping?
Every health professional I came in contact with warned me against putting a patch over my eye because if the eye happened to open under the patch you could end up with substantial scratching of the cornea when it came in contact with the patch. This may not be a real problem in your case because you have such good feeling on the surface of your eye... The tape works well because if it comes loose your eye opens and you say to yourself, "Oops, I need to retape my eye."
Keeping your eye safe at night
At night you should use a bubble type plastic patch that retains moisture but will not come in contact with the surface of your eye. Solan Ophthalmic Supply in Florida has a product called Nite-Eye, which is a clear plastic bubble with an adhesive "flange" that fits over your eye and retains ALL moisture. They say not to use it during the day, but if you were to put an opaque patch over it it functions quite well during the day. You can reach them at 1-800-535-4646 from 8 to 5 EST. They also have a web site at http://www.solan.com .
Saran Wrap might be even better:
My two surgeons and my opthalmologist all recommended the Saran Wrap patch at bed. They said that the Saran Wrap was very soft and would not damage eye if it came in contact. In 18 months of use it never did.
Or perhaps special contact lenses or glasses
You may want to ask your opthamologist about using bandage contact lenses (no correction). They hold artificial tears (celluvisc) AND protect the cornea, as well. I used for about 4 months until my facial nerve regained enough function to work on its own.
I have found a doctor in San Jose, CA, who makes glasses with an almost invisible moist chamber on. His name is Curtis W. Keswick. He can help you whereever you live in US. I have a pair myself, without them my eye gets red and hurts. [Editor: his e-mail address is <kes2020 AT hotmail.com>]
Plug it to achieve more comfort with fewer drops
I am a fellow ANer and I'm also a doctor of optometry. I've had my tear ducts blocked for nearly a year now and I'm quite pleased with the results. Many doctors will first insert temporary collagen plugs (they dissolve) as a trial for the first 10 days or so. If the results with temporary plugs are good, then you can proceed with a more permanent plug. This is an easy and painless procedure to perform; as with any medical device there are some shortcomings, but they are very rare. I do it routinely and the majority of patients are very pleased. I like to try the collagen plugs first if there is uncertainty about a possible improvement. However, in severe cases I bypass the collagen and go right to the silicone plugs, which can be easily removed. Most dry eye patients still need drops after punctal occlusion, but many are able to achieve more comfort with fewer drops.
I have suffered extremly dry eye for over twenty years. I decided to get a plug inserted into the tear duct and I can't believe what a HUGE difference it has made! The plug is inserted in the doctor's office and takes only a few seconds to place in the tear duct. I've had my plug for nearly a month and I hardly ever use medication during the day hours. I continue to use the night ointment since my eye does not shut tightly. I no longer have the blurriness that goes with using the good thick drops. I encourage everyone check into getting a plug! My only regret is that I should have had it done long ago!
All the physicians I have seen over the years have never mentioned the plug to me. So, I took it upon myself to locate an opthamologist who inserts these plugs. I found a doctor who specializes in dry eye. Yes, the plug is removable and could fall out if the correct size is not put in. The doctor told me that if it falls out, that he would insert a slightly bigger one. I used all types of eye lubrication to try to find relief -- it is terrible to not be able to find relief for a dry eye. Now, with the plug and depending on the amount of humidity in the air, I sometimes have to use the tip of my finger to remove some excess moisture!
The doctor thought it would be beneficial for me but had remarked that I was going to have to put some effort in closing the eye to spread the tears out: Think Blink.
My doctor did tell me that they must be well fitted. If they are too small they will fall out.
Put a gold weight in the eye
Implaning a gold weight is an easy outpatient procedure.
After using artificial tears for 31 years, I finally had a gold weight implanted last month in my eyelid. My cornea was wearing out from lack of lubrication. It is so nice to be able to close my eye completely and lubricate the eye at will. When I had my AN surgery in 1970, no one offered the gold weight. I don't imagine it was an option then. The wonders of modern medicine are amazing.
Or keep it up with springs
Springs are more effective than gold weights, if done properly. However, they are harder to get right -- experience matters!
At HEI, Dr. Levine did a spring implant on the affected eye [after surgery]. My nuero-opthalmologists in New Jersey state he's 'the only one who does it correctly, and operates the the way it is supposed to'.
If all else fails, consider more surgery
There are various surgical procedures which can provide protection to the cornea. They include a canthoplasty (bringing together tendon arms in either or both corners of the eye), a spring implantation in the upper lid, an elastic prosthesis secured through and around the upper and lower lids, a gold weight implantation in the upper lid, and a tarsorrhaphy (sewing the lids together). Here is a patient's story about some of these procedures:
I had a tarsorrhaphy of my right eye shortly after surgery for my AN almost five years ago. I really had no idea of what they were going to do or what it would look like. I was extremely weak and just went along with everything. The only thing I knew was that it was not permanent. At that point, as bad as I felt, that's all I really cared about. I'd say it was sown about half shut. It was absolutely horrible and ugly. When I got home and looked in the mirror I just bawled and called my mother who rushed right over I was so distraught!!
My facial nerve was reported at intact but it has never come back. I finally found out about other procedures from the eye booklet from ANA and had two gold weights implanted in my right eyelid and the tarsorrhaphy revised so it's just pulled in a little on each end. It's certainly preferable to the original tarsorrhaphy but it's still ugly. I use eye ointment all the time and a Saran patch at night. Depending on which doctor tells me, the eye is either great or needs to be sown entirely shut! Even after the weights were put in it hurt all the time until I found out about using the Saran patch at night. I'm still always conscious of the eye although it only hurts when the ointment is gone or I'm tired.
There's also a spring that can be put in the eyelid to make you blink (thanks to the nerve from the other side). I've been told both that it doesn't work and the spring has to end up being removed because it comes through the skin or that there's no problem with it. I know that your cornea can dry out very fast and it's nothing to mess with but don't get pushed into doing something rash like I did.
Last Edited: Monday, November 17, 2003