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Steroids only give me a temporary relief

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  • Steroids only give me a temporary relief

    Hi!

    I long time ago a doctor prescribed topical steroids, (based on Rimexolon). He said it might clear my inflammation. It worked perfectly for 1 week and I had completely fine eyes. Then the inflammation/redness went back and I stopped using it.

    After that he said I had blepharitis/mgd and there was nothing I could do.

    But when I read here some people use it for months/years. Why does it only work one or two weeks for me? Does anyone have a clue?

  • #2
    Hi! Maybe our experience might help on steroid eye drops.

    My daughter has been prescribed pulse doses of various steroid eye drops + antibacterial drops/ointments for inflammation since her dry eye started almost 3 years ago. For a year the MGD was undiagnosed and it was treated as chronic red eye inflammation of unknown cause. After tapering doses of the drops, the inflammation returned at once, with other corneal surface damage.

    We shopped around for new doctors who were current on examination, diagnosis, and treatment for improving MGD. It is rare an eye specialist will tell you what s/he doesn't know about eyes - they will stay quiet and try to look superior when you ask questions which is confusing and holds us all back. To be honest, the best information was here on dryeyetalk, Medscape, PubMed, and US and European national health service information sites.

    But when I read here some people use it for months/years. Why does it only work one or two weeks for me? Does anyone have a clue
    In our case, we have used FML on/off for years while we try to fix the MGD. The risks of cataracts and raised intraocular pressure are considered to be less on FML than other steroids. We don't use an immunomodulator because she has no surface sensation to warn of damage. Maybe this is due to chronic use of drops, as Rebecca and Prof. Christophe Baudouin and team tells us, maybe typical of paediatric eye surface.

    So steroid drops don't fix anything, just control chronic inflammation when needed. Some people have got a red eye after 1 week on steroids as they react to the other ingredients. There is also occurrence of raised IOP, which needs checking - see US FDA.

    I should say that in our experience the MGD is multifactoral, as Rebecca says: environment, diet, topical antibacterials as needed, short courses of oral antibiotics, lid hygiene, warm/cold compresses, maintaining eye surface with tear film substitute, have all improved it, and enabled us to reduce the need for chronic use of steroids. We are managing a 'spiral of improvement', reducing all drops as this happens to let the eye surface, aqueous response and meibomian glands recover. If we could manage on moisture goggles or wrap-around sunglasses I'd be even happier.

    he said I had blepharitis/mgd and there was nothing I could do.
    If you do have blepharitis or MGD there is plenty you can do. Do you think he is right?

    There are plenty of other reasons for lack of tear film or inflammation. You were thinking it might be allergy?
    Last edited by littlemermaid; 08-May-2011, 08:52.
    Paediatric ocular rosacea ~ primum non nocere

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    • #3
      Thanks for the info. At the moment I clean my eyelids and use tear substitute which help me a little bit. But when two different doctors prescribed topical steroids I had no idea what MGD was or that I had dry eyes at night.

      Now I'm curious if steroids would help me better if I also try to control my MGD. I don't think it's allergy.

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      • #4
        Have any of these docs assessed: tear break-up time (seconds to tear break up on eye surface with fluoroscein dye), tear production with Schirmer paper strips, meibomian gland function (consistency of oils)? You have discovered lots of allergies haven't you? And tried covering your eyes at night. Have you ever had eye infections? Have you checked whether you have normal meibom oil production in good daylight in a bathroom mirror (magnifying mirror is useful)?

        Meibomian glands, lower lid: we use 2 fingers under the lower lash and gently press, slightly upwards. If this doesn't work immediately, we slightly pinch. Keeping the lower lid edge off the eye surface you can see a line of tiny dots of oil in a normal eye. Afterwards, there should be blurriness in your vision if meibom has been expressed this way.

        Meibomian glands, upper lid: we use thumb and first finger, pull upper lid off eye surface, have a good look, slightly pinching. This is more tricky, but same.

        The best improvement we have had on MGD and 'ocular rosacea' is by addressing every possible factor: allergy in the environment, reducing surface evaporation (glasses, humidifier), eradicating bacteria on the face and eyes by hygiene, improving diet to include flaxseed and fish oil and reduce animal fat and sugar. Identifying rosacea triggers needs systematic dedicated patience, eliminating chemicals in bathroom and household products, which we are working on, and sticking to a pure healthy diet. With mild MGD or normal eyes, you can pretty much tell what you've eaten by the state of the meibom.

        Since it's been 6/7 years of red eye since you were 14 and you are still undiagnosed, I wonder if this multifactoral approach we use might help you pinpoint your triggers whether allergic or rosacea or other. Since you have had short periods of relief, something at some point has been working fine again for a bit then relapsed.

        Also, if they think it's MGD, I am wondering why they are only prescribing steroids rather than looking at possible inflammation triggers?
        I'm curious if steroids would help me better if I also try to control my MGD
        Do you have pain or surface damage or erosions that actually need steroids? Otherwise, why take the risks? I am worried that you might be in the position we were above, docs not current. I really think it's a question of finding a doctor you like to work with. Now some eye docs have learned about bacterial MGD, it seems they overlook the other causes of MGD, and the other causes of dry, red eye. Some newly-trained optometrists are getting good on dry eye diagnosis, especially, ironically, in the laser eye surgery business.

        Medscape link on allergic or inflammation causes of MGD http://emedicine.medscape.com/articl...clinical#a0217 My point is, it seems you don't have to have an itchy allergy eye, or obvious bacterial infection, to get inflammation MGD from environmental or dermatology triggers.

        Differential diagnosis - symposium for treatment of ocular allergies http://www.osnsupersite.com/view.aspx?rid=17129
        Last edited by littlemermaid; 09-May-2011, 05:37.
        Paediatric ocular rosacea ~ primum non nocere

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        • #5
          Littlemermaid - you are an amazing mum and so knowledgeable!

          I've learnt so much from your posts - thank you!

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