Well, I finally did it, I went to the US to get an opinion from Dr Tseng.

Flights to Miami were £370 return and fortunately I have a relative in Orlando who I met up with for the first time in ages. As a UK based dry eye sufferer I have to admit I was wondering if I was going to extremes but anyway what's done is done.

My experience there was completely different to all the pointless visits I have made here in the UK both privately and (especially) the lacklustre NHS. Instead of a 20 minute appointment with a "hmm...what a puzzle!" at the end of it, I spent a good 3.5 hours there undergoing various tests in the hands of his assistants. I wish I had gone over much sooner rather than wasting so much money back home.

At the end he sat down and diagnosed me with "conjunctivochalasis" and poor tear quality/production. He has suggested I try steroid drops for 3 weeks and see him again. I guess the steroid drops are to reduce the inflammation so that he can determine the most important contributing factor to my problem (chalasis vs other problems). I have to say he seemed very knowledgeable and much more eager to help. I have asked my GP how I can find someone here in the UK who might specialise in this kind of problem but I hit nothing but a brick wall. Sometimes I wish I could cancel all my NI contributions and spend the money myself. Is there someone in the UK who can help? Perhaps he's hiding under a rock? I feel like throwing a few rocks around sometimes.

I just don't understand why eye doctors here in the UK are so rigid in their approach to DES, they seem to think all you have to do is put in artificial tears and that's the end of the story, goodbye. Just hoping that the problem "goes away itself" is just not going to work for me.

Also I have been able to keep in touch via email with Dr Tseng and he has replied promptly to several follow-up questions I have had since returning to the UK. He definately has a good deal of insight.

Had you not been on steroid drops before?

Yes, I have tried steroid drops before. But shortly after using it they became ineffective (Dr Tseng reckons due to the preservatives). He has given me a non-preserved (refrigerated) bottle of dexamethasone. I didn't think the steroid drops are the long term solution though, I think they are to reduce the inflammation in the medium term so that he can better indentify the most critical factor(s) contributing to my dry eye problem. My understanding is that once you can deal with the underlying cause of the inflammation, you don't need anti-inflammatories. On the other hand if you haven't, inflammation will simply return once you stop the drops. I get the feeling surgery in almost inevitable.