Tear Break-Up Time and flap question

I had LASIK eight years ago which left me with severe night vision
problems. I've tried several types of RGP lenses but cannot tolerate
any of them for more than two hours a day. I have been told I have a
2-3 second tear break up time which is why I can't tolerate the lenses.


A second opinion surgeon is suggesting a flap lift to clean out scar
tissue followed by suturing the flap back down. She says I have high
and low spots on the cornea which is why the tear break up time is so
low. It sort of makes sense to me, visualizing wiping a squeegee across
uneven glass. The squeegee collects water from the high spots but not
the low spots. She is suggesting my eyelids are doing just that. She
says I cannot have more lasering because I'm 20:20.

I'm hoping the procedure will level the cornea and improve the TBUT.
Is that likely? If so, will that allow longer RGP wear?

TIA

 

Of course is makes sense that the TBUT would be affected by the
regularity of the surface. We see this all the time in the case of
EBMD, which is why dry eyes and EBMD often occur together.

What I don't understand is how this would affect contact lens wear,
since the "squeegee effect" would apply to the surface of the contact
lens, which is highly regular.

Perhaps the poor TBUT has other additional causes.

DrG

 

I hope Dr. Robins chimes in here, but I don't much like the thought of
sutures on the cornea. Seems to me they can cause some serious
astigmatism of the irregular (bad) variety, and the surgery itself could
cause MORE dryness (by additional severing of corneal nerves, thus
decreasing corneal sensitivity (again)...

w.stacy, o.d.

 

Thanks for the replies. I seem to have exhausted the other possible
treatments for TBUT: blepharitis treatment, cyclosporin, etc.
Although I'm 20:20 it's not quality. Even in rainy weather, like
today, it's difficult to see well. The RGPs solved 90% of my problems
but the poor TBUT makes wear time low. The surgeon is suggesting this
in hopes of clearing some of the HOAs. There was no mention of its
effect on contacts. I don't expect surgery will do much so I'm banking
on it improving the TBUT. Just wondering if anyone had been through
the process.

Kevin

 

Well, perhaps the proposed surgery WILL increase the TBUT when there is
no contact lens in the eye, but I doubt that it will have much effect
on the wearability of contact lenses.

DrG