Is there any hope?

Yes, absolutely. I've worked with people who have severe dry eye for almost fifteen years and I've seen many, many people in dire, hopeless states where there seemed to be no reason to believe things could get better... and I've heard from many years later and found they finally got to that "better" place and moved on with their lives. It happens all the time. One of the unfortunate things about the social media groups and forums is that people who get better usually go away. They aren't visible, therefore they don't exist, therefore nobody gets better, right? Wrong! But it might be necessary to carefully visit the meeting of the word "better" - for you personally.

WHAT DOES "BETTER" MEAN?

For many people with severe symptoms, especially if they're associated with one of the least "fixable" causes, the goal of returning to a baseline from years ago may not be realistic. The really vital part is not about "getting better" in the abstract, but getting better enough that you can move on with life without your eyes dominating your consciousness day and night. This is achievable. It can actually be very helpful to shift your thinking to identifying specific functional goals, rather than just having in front of you a moving target called "better". Think in practical terms. What is it you want to be able to do more of? More computer time, or reading, or regaining an outdoor activity you've had to give up? Sleeping through the night without getting up to add more lubricants?

Once you start looking at specific goals, the pathway to achieving them might start to look a little bit different. I think that a lot of people get stuck focusing exclusively on the medical side of dry eye. Think of dry eye as parallel paths: Yes, pursue the medical side, but pursue symptom management and quality of life improvements, including managing pain and managing the mental health impact, in their own right. So for example, many people spend years churning through all of the various medical treatments before they find that something as simple as dry eye glasses might actually help them return to doing the things they want to be able to do comfortably.

THERE'S ALWAYS MORE

One of the most frequent things I've heard from people over the years is, "I've done everything, and nothing helps!" Yet I could count on the fingers of one hand the times when I think that's actually come anywhere near being true. Drops, plugs/cautery, Restasis & Xiidra, a handful of MGD treatments, even autologous serum drops - these are nowhere near all there is. If you're feeling downhearted about there not being enough available solutions, you might want to browse the TFOS DEWS II Management and Therapy. It's very technical of course. But just the vast array of things that have been used for dry eye will blow your mind. There are also many new drugs under development. More often, though, things you think you tried actually need to be revisited.

We'll talk more about this shortly, when we get to "I've tried everything. What now?"