Re: Bloodwork drawn once yearly?
Just to play devil's advocate - or rather veterinarian's advocate! - signs don't trump blood work. This is especially true of very nonspecific signs like goopy/tearing eyes, sensitivity to touch or not running around. For example, if you tell your vet something like "I've been increasing the dose every week because she still has runny eyes" you can expect some pushback and it's justified. If it's something like "I can tell she doesn't feel good", same scenario. You may be 100% correct that she doesn't but there are many, many possible explanations.
It will help if you can be more precise and organized when talking to your vet. Instead of "I think she needs more because she has runny eyes", "Her eyes have always been an early sign her ACTH is out of control and that is soon followed by laminitis" would be more convincing.
If your horse has a significant problem like PPID there is always going to be a tendency to blame everything you see on PPID. Same thing happens with other disorders like EPSM/PSSM.
Pergolide is generally well tolerated but the real potential for harm here is that something else will go undiagnosed. For example, horses that are not eating well and not feeling well could have a simmering colic issue that could kill them.
If lab work is not an option for whatever reason, talk to your vet about putting together a list of danger signs that fit your horse's presentation as well as known red flags for PPID in general. For example, unexplained weight loss, loss of topline and weakness of the abdominal muscular wall, slow shedding or other coat changes. You should both agree on this ahead of time and you should at least let your vet know when you see something and adjust a dosage.
Shop around until you find a vet to work with you on this.
As an aside, horses don't have symptoms. A symptom is something the patient verbally complains about.
Eleanor in PA