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How many quality opinions did your friend get? I also know people with DED and from my experience not all docs understand the disease well. Obviously you know more than I do, but I'm very skeptical that there isn't more to the story than "a lifetime of drops". Also, I hope your friend has tried autologous serum drops.

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That is a great suggestion IMHO. ASTs are pretty amazing but they're not a cure for everyone.

In the case above, I'm referring to my spouse. Her entire family has this problem - dry eye, frequent / continuous corneal erosions - setting in by their mid-late thirties. These are the people who end up wearing sleeping goggles, ointment, taping their lids shut, etc. It's not a lack of tear production, it's poor corneal basement layer adhesion for some undiagnosed reason and, probably, eyelids drifting open during sleep.

Ciclosporin 2% eyedrops and/or punctum plugs may be useful. I home she'll get better eventually.

she went way past both of those. it was not a fun time getting things compounded.

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