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  • Fluorometholone Question II

    My ability to focus on my work, on really anything has slipped during my healthcare crisis of the last couple of months. Iíve attributed this to stress and/or depression and/or social isolation of working at home for the last few months. (My job is 90% applied research and education, so with the help of a supportive boss am lucky to have this option. I find managing my condition much easier at home.) But more reading and thinking and a conversation with my pharmacist has me wondering if Fluorometholone is part of the problem.

    One of the many lessons for me during this recent dry eye adventure has been seeing the annoying results of using large doses of systemic steroids to get at eye inflammation, irritation, etc. Like using a chainsaw to cut butter. During one round of prednisone in August Ė among other side effects Ė I averaged just 4 hours of sleep a night for over 2 weeks. My eyes were only somewhat improved.

    Fluorometholone has been the ďsolution.Ē Donít treat the body to reach the eye; just treat the eye. Now, as part of a Bridge Regimen to get me to early 2014 with a parallel therapeutic solution, Iím on one drop of FML 3X daily for each eye. All of us doing eye drops worry that what weíre applying to our eyes may be getting absorbed into our sinus lining, into our systems. Me too. As this inability to focus has become an issue since early September when I began stepped up FML, perhaps I need to understand if my attraction to distraction is due to absorbing steroids through my eyes. Reading online, Iíve not found this effect to be on the short or long list of FML side effects. I canít find any articles that speak directly to the issue.

    So I asked my pharmacist what he thought. This is smart guy who reads everything in his field; heís been very helpful to me on other issues. His take, qualified by his saying that this is just 2 cents from your pharmacist, is that a) FML is powerful, b) Iím taking at higher than usual dose over an extended time period, c) Iíve not been pinching the inside corners of my eyes to control drainage (something Iíve started doing), so d) yes, the potential is there for a steroid introduced through the eye to have systemic effects.

    So Fluorometholone Question II is: Has anyone dealt with this? Read something useful? Discussed with a doctor?

  • #2
    .

    just playing devil's advocate here but, he's only a pharmacist. he may be talking to the audience (i.e., you), instead of talking to the facts. you may be hearing what you want to hear.

    I had to take steroids for my breathing many years ago due to a systemic issue I had. I took care of the issue and didn't need steroids.

    I too feel all this is systemic so I went absolutely hardcore in that I went vegetarian, only water for fluid, forced myself to drink two gallons of water daily, dropped a ton of weight, exercised like crazy and things got better.

    granted, Restasis probably was the main contributor to my getting better, but the lifestyle change definitely reduced inflammation.

    the biggest contributor to my getting better was very simple but the hardest thing to do: reduce stress and increase sleep.

    I made a point to ensure I slept 8 to 9 hours a night uninterrupted. whatever it took (minus heavy drugs to do so)... I also made sure to just chill out more. take vacation days scattered throughout the week and just mentally scale down. months of this and I felt a lot better. Stress is crazy. last year I injured my eye in sports bad and got a bad infection, workload was immense, and I was caretaking for my father who was dying. the stress had it such that I literally was paralyzed partially in my face and showed signs of MS. There's nothing I put past stress therefore it was the first thing I wanted to curtail.
    Last edited by DryInUpstateNY; 02-Nov-2013, 22:27. Reason: mispelling

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    • #3
      DryInUpStateNewYork ~ very, very good and inspiring advice, thank you.

      William ~ we've been using FML, Prednisolone PF and Dexamethosone PF, paediatric, for 5y on/off. Mainly FML because it doesn't raise intraocular pressure (IOP) so much. Still not thrilled because it has preservative BAK, not good for the eye surface. But always on a tapering regime, from 3/day to control flareup, to as little as one drop in 10 days for a tiny bit of control on chronic inflammation (maestro). Can't risk chronic inflammation with kids, but now my daughter is mid-teens we are off FML until needed for flareup. Keeping in mind there is a long-term cataract risk, worth discussing your suspicions again with someone who knows what they're doing.

      Are you using the computer all day?

      Totally agree with sainted Pharmacist on a, b, c and d. Who is this guy and is he single?
      Paediatric ocular rosacea ~ primum non nocere

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      • #4
        Thanks for your input and ideas!

        Let's see:

        ~ he is just a pharmacist but, so far, is more tuned-in to drug effects and interactions than my doctors
        ~ there's always the potential of folks telling me what I want to hear; he's not done that on other issues; comes across kinda clinical, but could be. I sometimes hear what I want to hear. Just trying to nail down this lack of focus.
        ~ he's married. ;-} He and his wife own a small chain of pharmacies up here in the northwoods
        ~ I think DryInUpstateNY that you're onto something with the diet, exercise, etc to strengthen and make more healthy the whole system, and stress as a key, if not the key factor. My health crisis in 2013 has been about 2 linked components. One involves the collapse of my immune system late-2012/early-2013 and, a couple of months later, the second issue was the end of effectiveness for a round of immunotherapy that has given me awesome relief from 2007 until early this year. So, in addition to now pursuing another accelerated round of immunotherapy am also working out, walking, eating super-healthy, drinking lots of water, etc.
        ~ Stress. When my eyes were crashing constantly during July and August, before this bridge regimen kicked off in early-Sept, I had time to just sit in the dark and think all of this through. I've moved 3 times in the wake of the Great Recession. 3 different cities and states, 3 different jobs. Been away from my wife; she's holding down the fort in yet a 4th state. I don't know that I had a lot of choices - am not a point in life where I can just give up work - but I think the stress of all the moving, adjusting over and over to a new apartment, job, life, etc. just caught up with me early this year. I've got some routines in motion that address this (see above) but am definitely not getting enough sleep, like you mention. Will try to work on that.
        ~ the ophthalmologist who prescribed the steady dose of FML said my IOP had been consistently low and that's why this was safe. I have another issue with this prescription - see other DET thread = Fluorametholone Question I - but am assuming the IOP info is accurate. I'm seeing a oph specialist on allergies and dry eye in early Dec so I'll have a chance to ask about both issues.
        ~ I don't use the a computer all day, but am definitely on too much. My work involves organizing and analyzing data, writing reports, collaborations with colleagues via email, shared websites, etc. It's really hard to not use the computer a lot. So far, I think my employer is letting me do this work-at-home thing because, while my productivity is down, I'm still putting in about 40 hrs a week and getting some stuff done. This means computer use.

        Another theory I have about my lack of focus is that all my professional career I've been, if not a workaholic, definitely work-centered. Now, for the first time in 24 yrs, I've placed something above work. My health. There's, of course, no way around this. My allergies and eye conditions have taken over my life and I'll only improve if I focus on health first. But that means that work is something I'm not pushing all the time. If a colleague calls I might pick up. If a doctor calls, I always pick up. I adhere to my workouts and walks, my meds and treatments religiously. For a work project, I do the basics needed to get it done.

        Still hoping for clarity about FML possible systemic effects.

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        • #5
          Lots of asthmatics use inhaled steroids for decades (I've been on them for 40 years so far). You could check the research on systemic effects of inhaled steroids and base your decisions/concerns on those findings, perhaps.

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