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Ophthalmology & Optometry/corneal insensitivity/caused by diabetes

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Dear Dr Shroff, Dr Shroff please help me if you can. Please tell me something can be done for this condition. I am a diabetic(type 2). I have all the major complications of diabetes. I have neuropathy(poly). Gastro, urinary dysfunction( both conditions caused by neuropathy) slight kidney disese(stage 1). Their is nothing I can do about those complications. But I am hoping to God their is something that you have heard that can help treat corneal insensitivity that diabetes causes. The results are chronic dry eyes. Even though out of all the complications from diabetes I have, it seemed to be the least important of all the rest in terms of its severity or importance, but I just realized just how important it is to try to treat this condition, and cure it if possible. I cannot produce any tears. I went to a funeral of a close family friend, and could not produce any tears. I was devestated, because I was crying but no tears were being produced. I went to my optomologist, and he prescribed me restatis. It has not worked. He also prescribed me eye drops to lubricate my eyes(systane). They give relieve, but i still cannot produce tears(I know this, because I cry when my nerves(neuropathy flares up). I am devestated. This disease has taken a lot away from me now it looks like it is going to take my ablilty to produce tears. I think the condition is called diabetic kerothapy or corenal anesthesia. I have found out that restatis is only effective for dry eyes that is cause by inflammation, and even if that is the cause of the dry eyes, restatis is only 25 percent effective.  I am convinced that my dry eyes are caused by diabetes, becasue I have other problems with my eyes that I believe diabetes is responsible for(cataracts/lattice degenration). Dr Shroff, if you have heard of anything. Anything. Anything that can treat corneal anesthesia, be restoring the sensitivity to the cornea, please tell me. I have been on the internet, and I have read where there are 4 other treatments that are used to treat this condition. They are 3 drugs(Lacrisert, hydroypropyl cellulose, and Naltrexone Hydrochloride(I don't think Naltexone Hydrochloride is approved yet, but from what I read it is the best of the 3). Also a lot of studies point out that insulin(eyedrops) also restores corneal sensitivity. Dr Shroff, please, please share with me everything you know, that can possible assist me in restoring corneal sensivtivity to my eyes. drugs or herbal. Anything. Approved or not approved. I would hate to contemplate of going the rest of my life without not being able to produce no more tears. Any knowledge/opinion that you can give me that can asssist me in possible restoring my ability to be able to produce my own tears again, I will be forever grateful. Thank you. Elbert Vaughn

Answer
Dear Elbert,

Couple of points here:

1. You need to see a cornea specialist as he / she will be the best guide for dry eyes. Dry eyes needs a step wise treatment. The dryness needs to be scored. treatment needs to be monitored. sometimes plugs in the tear duct need to be also considered

2. Diabetes should be in strict control. A good diabetologist would be able to highlight on the insulin eye drops, though we have not seen its use in our practice. you may also need some vitamins to improve neuropathy, again, your diabetologist would guide you regarding this.

3. Frequent breaks on the computer as this could aggravate dryness easily.

4. All in all, this needs a step wise plan as said above.

The eye drops you mention are also similar to the action of Systane and Restasis, would not recommend anything herbal or new where scientific basis is not available.

Hope this helps.

Anand Shroff

Ophthalmology & Optometry

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Dr Anand Shroff, MD, FICS

Expertise

I can answer any question on eye care, expertise in Laser eye surgery, LASIK, Epi LASIK, cataract, glaucoma, keratoconus- corneal collagen crosslinking.

Experience

OF LASIK, we are one of the first centres to use the wavefront guided LASIK or custom LASIK procedures. I train doctors worldwide for these wavefront procedures, our centre is the referral centre for our Wavelight Laser Technologies, Germany in India.

Organizations
ASCRS [American Society of Cataract and Refractive Surgery]certified by USA- Joint Commission International

Publications
http://www.shroffeye.org

Education/Credentials
MD Ophthalmology and FICS [Fellow of the International College of Surgeons]

Awards and Honors
please see http://www.shroffeye.org and www.lasikindia.in

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