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MGD from Accutane

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  • MGD from Accutane

    Hello. I first want to thank Rebecca for this site. I am long term reader of the forum posts, and first time contributor. Over the years, the feedback from the contributors has been a great source of comfort. Considering my increasingly worse dry eye situation in the past year, I wanted to share my story with the user group in an effort to find some hope.

    I was afflicted with dry eyes back in 1995 after taking Accutane. It has caused severe meibomian gland dysfunction (MGD). Over the years, there have been extreme periods of eye pain, headaches, and lately, anxiety coming from triggers that have aggravated the situation. Many years ago, I had bad reaction to topical aesthetic eye drops (Opsthetic) and flourescin eye drops given to me for a typical glaucoma test. Also, usually, after taking an antibiotic, my dry eye discomfort intensified for up to 9 months afterwards. I have had other situations where my dry eye pain became worse after a dental exam irritated my mercury amalgam fillings, and even had a bad reaction to flax seed or fish oil supplements (not sure which).

    Historically, I classify my MGD dry eye situation as either "manageable" or not manageable. I understood over the years that when it's relatively manageable, it's just always on the cusp of being pushed over to the other unfortunate side. My best protocol has always been to avoid taking any medications that would aggravate my pre-existing MGD. When I was in a manageable time period, my main dry eye MGD regimen over the years has included daily lid scrubs, warm compresses as needed, OTC preservative free eye drops (a lighter bend of Tears Naturale now called Genteal), and Restasis since 2010 that I have found to be beneficial. However, when my situation becomes not manageable, it seems that nothing I do helps. In these times, I would increase my compress routine and begin to take thicker drops (including Refresh Optive Advanced and Retain) and Refresh PM nighttime ointment.

    Since September 2017, my MGD situation has become much worse, and I am not getting any production at all from my meibomian glands, even after warm compresses. Historically, my symptoms included dry eye pain and irritation severe headaches throughout the day. However, the symptoms this time around have morphed into a feeling of anxiety and weakness and general uneasiness, that has overshadowed the headaches. In all the years suffering with dry eyes, I never felt this way.

    I cannot identify any obvious trigger for my current increased dry eye pain. I can only speculate about sunblock paste that I used on my neck and face about a month earlier that could have been absorbed into skin. I have not read any evidence to support issues with sunblock on MGD dry eyes, but it does seem to have some toxic ingredients that could cause havoc with certain glands such as the thyroid. BTW, I was diagnosed with an overactive thyroid from Graves disease a few years back and was successfully treated with methimazole for over 2 years to bring my thyroid back in line. Fortunately, at the time, I did not have any additional side effects related to my eyes, and I was able to wean off the medication a couple years ago.

    So in the past several months, I have been trying to explore other avenues to see if there could be something else in my body interfering with my Meibomian glands. I have seen my general doctor, an Allergist, Rheumatologist, and Endocrinologist and have received a ton of blood work. Nothing significant to report other than a positive ANA antinuclear antibodies test, which I was told is likely the result of my past Graves disease diagnosis. I even explored an impact of the mercury amalgams in my mouth, for which I have 8 currently in my mouth. The blood work for mercury toxicity was in the normal range. However, the more reliable (from what I am told) hair follicles test for heavy metals indicated that I was at a toxic level for mercury (0.113) and aluminum, which is basically any measurable trace in the body since they are toxic metals. I'm not sure if and how I should proceed with this information. Will it benefit my eyes if I get all the mercury fillings removed and consider a chelation program? Also, my latest blood work of thyroid TSH levels indicate that it is still within the normal range, but are considered to be low/normal on the borderline, heading toward a hyper-thyroid. As a result, my endo doc prescribed a low dose of methimazole hoping that would help with my dry eye symptoms. Its been 3 weeks and no benefit yet.

    In the past months, I have been working with my dry eye specialist doctor in New York to try to find relief. I have tried a 6 week regimen of salmon oil. I even tried Xiidra for about 6 weeks, but neither have provided any additional relief. I'm at a point of desperation now and I would like to try any other modality for my MGD that could provide some relief. My dry eye specialist doctor wants to hold off on steroid drops, especially considering my past sensitivity to BAK preservative in many of these products. He is considering steroids as the last resort, and will prescribe dexamethasone when that time comes. I wanted to explore any other treatment that would provide relief for my MGD situation. As of now, I have never tried Lipiflow or IPL therapy. I am also interested in Meibomain gland probing.

    Sorry to be longwinded in my dry eye biography, but if anyone can provide any feedback or offer any advice on my situation based on their experiences, I would greatly appreciate it.

    Thank You for listening,
    KeithM
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