I agree that ointment is a good recommendation at night and I do use
ointment at night.  But, what is one to do when it fails?  My prior doctor
just kept telling me to use it again and that was it.  I was getting
erosions about twice a week and they were occurring in greater frequency and
intensity.  Honestly, it's really not difficult at all to find a bottle of
artificial tears with one's eyes closed.  It's always on my nightstand along
with an additional bottle in the drawer.  In any event, if one can learn to
awaken with their eyes closed, it's relatively easy to add drops.  The real
question I have is if one can keep the eyelid from pulling the epithelial
cells off every morning and avoid all erosions, will real healing eventually
occur?

Mike

I myself have frequent dry eye on awakening. Haven't goten an erosion yet,
but I follow my own instructions - I keep a bottle of tears where I can get
to it by feel, and if my eyes are not feeling right, I just open a crack and
put in the tears, and massage it a bit to distribute it. I also use this if
I wake up at 4 am to go to the bathroom, and can't open my eyes.

On 5/10/05 9:50 AM, in article
1115743816.375824.235350@f14g2000cwb.googlegroups.com,

Brushfire - (this is a really long post....sorry)  I'll tell you what I
would do if I were in your shoes...this is only my advice, as always check
with your doctor first.  Also, everything in this post is my own personal
opinion as to what I would do if I were you.  As you know, I'm a prior
sufferer of RCES and I became erosion free overnight with this technique
along with applying a nightly ointment.  But, ointment alone failed me
miserably.  As I've stated before, if the eyelid is ripping the cells right
off the epithelium upon awakening, it makes much more sense to me to
intervene right before it happens rather than an ointment eight hours prior.
But, better than that I say why not do both the ointment and the drop
technique?  I'm not a doctor so check with your doctor before considering to
apply or utilize anything I'm suggesting below.  These ideas seem totally
logical and work great for me but check with your doctor first.

Regarding how you sleep, I used to sleep the same way.  I think you are
"right on the money" when you mention your pillow possibly causing your
eyelid to move.  Also, you may be sleeping with your eyes partially open
which will also contribute the ointment not lasting as long as well as the
ointment sloughing off onto the pillow.  I think anything that can move your
eyelid in your sleep risks an erosion including you moving when your eyelid
is pressed against a pillow.  But you also have to ask yourself how often
you get an erosion in your sleep versus how often you get them right when
you awaken?  Most get them upon awakening.  Still, there's lots you can do
even when you are asleep but chances are, most of the time it will be when
you awaken.  Also, if you awaken, and apply the tears, I think it's really
going to help more cells really stick down.  In other words, even if you
don't get an erosion, when you wake up and your eyes are dry, your eyelids
are still sloughing off a lot of cells, just not enough to cause you a lot
of pain.  But, perhaps enough to make it so your eyes just don't feel quite
right.

I put most of the pillow slightly higher on my forehead and it only slightly
touches my eye so there is a slight gap between my eye and the bed although
my eye may slightly touch the pillow or the bed.  If you are really
concerned about this, you may want to check into an eye mask;  I never
needed to though because adjusting the pillow has thus far worked fine for
me.  Some RCES sufferers even sleep with goggles.  Frankly, I don't like
altering how I sleep and I prefer to sleep in the same postion but it was
relatively simple for me to move the pillow up a little higher more to my
forehead.  I even try to make it so that it slightly presses so as to try
and keep my eyelid closed.  Sure, people move around in there sleep at night
and stuff but if I can start in one position then hopefully it can become
second nature and I can be more aware of what is natural even if I wake up
slightly, toss and turn, and go back to sleep hopefully it will be in that
same position.  However, I still believe if one wakes up with their eyes
closed and applies artificial tears very few cells are going to slough off
compared to adding no tears.  Even if one does not get an erosion in the
morning, logic tells me that more cells will be sloughed off than if one
adds artificial tears as soon as possible.  Therefore, if fewer cells get
sloughed off, healing will occur faster and thus make it even less likely
that erosions will occur under any conditions while asleep.

Next, I'm sorry you have been suffereing with it for so long.  My doctor
told me today that one has to go at least a year for the epithelial cells to
really "glue down" to the cornea.  I've gone almost 11 months and I'm very
much in control of my RCES but it's almost all due to applying this
technique while also using a nightly ointment.  If you are having serious
erosions every few months then it sounds like the cells are just sloughing
off again and again and you are just going back to where you were a few
months ago and there is no true progression.  I agree 100% with AJ that the
longer you go, the fewer erosions you have and with less intensity.  In
fact, the more severe the erosion the more set back you become because more
cells have sloughed off.  Therefore, the less severe the erosion, the less
set back you are.  But, this is important because when you get a "minor
erosion" you have to REALLY be on your guard with this method and make it
work All too often a major erosion will follow within 1-14 days.  But, if
the eyelid feels cemented to the eye it should be all the easier to wake up
with your eyes closed and add drops before opening them.  You might even
find yourself opening your eyes and stopping as you reprogram yourself and
learn the technique.  Also, you may wake up several mornings with your eyes
closed where you can actually feel your eyelid cemented onto your eye. My
doctor says I can add as many artificial tears as I want so I just drench my
eyes with artificial tears in the morning (not Muro 128 drops) every
morning.  I don't even test to see if my eyes are dry or not.  I just add
artificial tears every single time I wake up no matter if it's morning or
the middle of the night.  I probably add at least 5 drops.  I carefully
insert the tip of the bottle in the corner of my eyelid so that the drops
are going right onto my sclera and not outside my eyelid.  I'm curious as to
what your doctor has recommended or if you have mentioned to him/her your
situation.  Also in all the years have you seen one or several doctors?

Personally, you did not describe just how "serious" your erosions are every
few months.  But, I can assure you that when I had that massive erosion last
year with huge pain and my vision did not return to normal for 10 days it
did not take long for me to learn to wake up with my eyes closed.  I would
hate to go through that pain ever again.  So, even after 11 months I try my
best not to get complacent with this technique.  It's just too important so
I really have it programmed in my brain where it becomes second nature.  In
another post here I mentioned that I'm considering putting together a
non-profit website with what has worked for me.  For one thing, what worked
for me was every night I made the mental affirmation and after not even a
few nights it was easy to wake up with my eyes closed.  It got to the point
where I think I woke up even as my eyes started to feel dry just based off
of classical conditioning.  Anyway, if I put together this website here is
#3 at this time on my list of many details:  3.  The Affirmation:  Every
night you must make a mental affirmation to yourself.  Something like:  "I
will wake up with my eyes closed, still and relaxed or I risk being in
horrible, excruciating pain."  Hopefully that will be enough to keep you
from opening your eyes before adding artificial tears otherwise you may need
to .....".  Even if you accidentally open your eyes, just immediately grab
the artificial tear bottle and gently close your eyes, add artificial tears
and wait about 20 seconds until you really feel the artificial tears
throughout your entire eye.  If you don't feel them then add more.  You
can't get lazy with this method for it to work.  You have to add the
artificial tears every single time you wake up and you must aim to wake up
with your eyes closed, still and relaxed.  Don't squeeze them tightly closed
either.  The action of waking up and squeezing the eyes closed tighter will
force your eyelid to move across your eye which could cause an erosion.
Just keep your eyelid muscles relaxed.

If I were you I would try and get out of the habit of waking up every two
hours.  You are adding a nightly ointment every two hours and it appears to
me that it is failing you if you are getting erosions every couple months.
What does your doctor say about this?  It's not working anyway since you
said you are getting an erosion every few months.   Rather, I would add
ointment at night and try to sleep through the night.  Just tell yourself
that every time you wake up (even if it's in two hours) you will wake up
with your eyes closed and add artificial tears.  Then, after opening your
eyes consider adding your night ointment before going back to sleep but
that's only if you wake up in the middle of the night.  When I wake up in
the middle of the night I add artificial tears, open my eyes, grab my
booklight off the nightstand and add an ointment and go back to sleep;  I
don't feel like getting out of bed to add ointment so I just dab it on my
finger and put it in my lower eyelid;  in almost a year, I have not had any
infections by applying it with my finger.  If I'm somewhat awake I'll
sometimes exhale hot air onto the muro tube so as to slightly warm the
ointment but still, since I don't have any erosions my eyes tolerate it just
fine.  Sometimes I'll doze off for as little as 15 minutes in the morning
and I'll still add artificial tears again...it's just not worth the risk
otherwise.  Perhaps you might be sleeping with your eyes slightly open which
can cause excessive dryness.  But, if I were you, I would still just add the
ointment at night and try to sleep through the night (or as long as you can
since you are in the habit of waking up every two hours now).

What you write about the DOT at 7 o'clock never going away could just be
indicative that your eyes just don't feel quite right because every morning
(or even several times in the night) when you wake up your dry eyelid
continues to rip the cells right off your epithelium even if it does not
feel painful.  It's only when it's painful that you call it an erosion.
But, perhaps cells are sloughing off every time you awaken and more than
your eye can repair before you again awaken.  For what it's worth, from what
I have been told, most erosions occur around the 6 o'clock area of the eye.
But, wherever they are, the important thing is to stop them so that one is
not set back every time they get one.  Major erosions set you back a lot
more than minor ones.  After minor ones some of the "glue" is gone so if one
gets one they should really be steadfast in using the technique (especially
for then next 3 weeks).

Regarding reading the newspaper a few things.  I know a long time ago when I
had erosions I can say this:  sometimes I would wake up in mild to  moderate
to severe pain.  But, all the other times perhaps I did not feel pain but
cells were sloughed off enough such that if my eye were in certain positions
I would feel almost like a stabbing pain.  I can remember when I would look
way up it hurt....bad.  What happens is when you get an erosion, part of the
epithelial cells slough off.  Next, the surrounding cells of the epithelium
"fill in the gap."  After an hour or a day or 10 days and the pain is gone
one thinks all is well and they are healed and back to where they were right
before the erosion.  But, this is not true.  They are set back because the
epithelium is now thinner than it was before.  I compare this to filling a
glass with water (where the water is the epithelium in this analogy) and
scooping out some water from say the 7 o'clock position or wherever in the
cup.  That gap is the erosion and the surrounding water quickly fills in the
gap (but the eye takes longer of course).  Now the water is level again but
there is less of it and such is the case with the amount of epithelial cells
or glue that holds everything down.  This is the understanding I have from
my ophthalmologist.  So, the idea is to go as long as you can without an
erosion and without ANY cells sloughing off so that all the cells have time
to really stick down.  My understanding is that you have to go at least
year.  But, I know for me, since using this technique I feel in total
control.  There is no uncertainty.  I know I won't wake up with an erosion.
If I get a little lazy and my eyes even feel the slightest bit "not right"
or slightly irritated in the least I'm right on it.  It's like a wake up
call to always wake up eyes closed, still and relaxed before adding drops.

All the best,
Mike

Wow, Tom.  This looks like a classic case of "floppy eyelid syndrome."
No kidding.  People with this syndrome often suffer from sleep apnea.
The constant burrowing of the head into the pillow creates a bad case
of exposure keratitis via the open eyelid as well as the cornea coming
into contact with the pillowcase.  The treatment is to first eliminate
the sleep apnea.  You might also consider using a long strip of 3M
Millipore tape to keep the eyelid taped shut.

DrG

Mike,

I agree that using ointment after an erosion has already occurred is
not the best course of action.  Pressure patching the eye is probably
the better option.  As an eye care professional, I prefer to use a
bandage contact lens instead of pressure patching.  The contact lens
protects the cornea and facilitates epithelial regrowth.  However, this
should only be done under a doctor's supervision, and then along with
the use of a prophylactic antibiotic.  Once the erosion has
re-epithelialized, I think that the hypertonic ointment should be used.

In the long run, prevention of the erosion should be the goal, and I
feel that a light petrolatum ointment used nightly can help.

DrG