Is this MGD + something else? Help me while I wait for the specialist (months long waiting list)
After months of trying basic advice and useless eye drops from my GP, I've finally been referred to a specialist. But the waiting list is months long. While I wait for the specialist I'd like to get an idea of what my diagnosis might be, and also go to the appointment better prepared, or if i should ask him for any test, treatment or anything specific based on my profile. I had a talk with Claude and this was his diagnosis: Chronic evaporative dry eye syndrome with atopic inflammatory component and corneal trigeminal sensitization.
I started having eye discomfort 3 years ago. I thought it was caused by work (I use a computer 8 hours a day), it lasted a few weeks but then went away on its own. After that, it started happening more frequently, and for the past year I've been experiencing it daily. It started gradually but my eyes have become increasingly sensitive to triggers over time.
It's mainly typical dry eye/MGD (redness, dryness, irritation, eyes also get watery). Although I have better and worse days, I've clearly identified the following triggers:
- Driving — eyes worsen almost immediately
- Screens — computer monitor triggers it, phone screen does not
- Shopping malls
- Cycling/wind
- Drinking alcohol
- Being outside during the day when there's no direct sunlight
If I avoid these triggers my eyes are 99% fine, but unfortunately that means staying home or only going out to get direct sun. They've become increasingly sensitive over time, before it was mainly the computer that caused symptoms, now the list is longer.
One thing I've noticed: at work I'm constantly uncomfortable, but when I go outside in direct sunlight my eyes calm down almost immediately and all symptoms disappear (redness, irritation…). Unfortunately as soon as I go back into the office they get bad again. When I work from home my eyes are considerably better than in the office, I assume because of the air conditioning.
About a year ago I also started noticing typical small black floating spots (most noticeable against light backgrounds like the sky), which appear when I blink or move my eye and disappear after a few seconds. Worth mentioning that I am myopic. These floaters have not gotten worse over the past year, but they are still there.
Some additional context that might be relevant: I have a history of atopic conditions (allergic rhinitis, eczema, high IgE ~515 kU/L), which makes me wonder if there's an inflammatory/immune component to my dry eye rather than purely mechanical causes. The sun relief in particular makes me think this. I´m also B12 defficient, i took methilcobalamin 1000ug pills, which made my dry eyes much worse so i had to stop it.
I also took finasteride 6 years ago for 1 year, but didnt experience any dry eye sympthoms, also took dutasteride for another year, but my symptoms are worsening now, and i´ve been 3 years without taking those pills.