I’ve tried everything. What now?

THERE'S ALWAYS MORE.

No one's tried everything. There really is always more. In the old days, I used to hear from a lot of people who said they had tried everything, when really what they meant was they had tried every OTC drop on the market. Then it was drops, plugs and Restasis. Then it was ditto, plus Lipiflow.

These days, more and more people are very well educated about a wide variety of dry eye treatments, and when they say they've tried everything, some of them have a far longer, more involved list. But it's still not everything. TFOS DEWS II Management and Therapy report is pretty exhaustive, though, so for those who really think they've tried everything, that's something worth exploring. It will probably make you feel like you've just scratched the surface!

BUT FIRST... CONSIDER A VARIATION ON A THEME.

With dry eye, it's all about the proverbial devil in the details. You may say you've tried everything, but that may simply mean you've dabbled for a few weeks or months in each thing you know about. You have not exhausted the possibilities. Sometimes what seem to be small differences make a big difference. You may have done lid scrubs and compresses for a long time - but maybe a different product will do better. Maybe you're getting your compresses too hot, not hot enough, too long, not long enough. Maybe you tried scleral lenses - but maybe they were too large or too small diameter to be comfortable on your ultra-sensitive eyes, or maybe a different coating or cleaner or saline would have made all the difference to a burning sensation you got when you tried them. Maybe you tried autologous serum, but only 20%, not 50%, or maybe platelet-rich plasma would have helped more. Maybe you tried Restasis, but gave up because it burned, and that's a totally legitimate reason to give up on a treatment for your already burning eyes, BUT what if you are one of those few that Restasis actually could help significantly and what if you could buffer that burning effect by putting in artificial tears 15 minutes before your dose? You get the point. None of these treatments are a simple binary "it worked" or "it didn't work". There are variations on a theme that might be worth trying. If your doctor has ever seemed frustrated that you've given up on things too quickly, it might be worth having some more conversations.

AND ALSO... CONSIDER RE-VISITING YOUR GOALS.

Sometimes when you have been battling dry eye for a really, really long time, you can get lost in the details of the medical side. I've noticed this more and more with people whose main issue is chronic meibomian gland dysfunction. Sometimes you can lose sight of the real goal - which is comfortable vision, right? - and instead be focusing on some perennially elusive state you want those glands to get to. It's understandable, because people are afraid of atrophy of the glands. But... I know people who are living well with absolutely no functioning meibomian glands. I'm not suggesting you neglect them, or fail to pursue the treatments that are available. I just want to suggest that you periodically revisit what you're trying to achieve, and keep an open mind about how to get there. Not all solutions are medical.