Could laser on my eyelids have caused MGD?

[redandunhappy]

Hi all,

I have been recently diagnosed with blepharitis & MGD, and evaporative dry eye.

I have had mild rosacea for a number of years so I'm wondering whether I'm just finally sucuumbing to ocular rosacea. I do have a some new red veins in my eyes that I never used to have, and I've read (on this forum) that this is a sign of ocular rosacea.

However, there are some other possible causes that I'd really like to rule out first:

My problems started a few months after I had some laser treatment on my eyelids to get rid of the very prominent veins there (I suffer from mild rosacea on my face) and I wonder whether this laser treatment might have caused my blepharitis - does anyone have any thoughts about this? I hate the thought that I could have brought this horrible condition on myself.

Someone posted here that having laser on your eyelids is a bad idea because any inflammation (my eyelids were quite swollen for a few days) can bring on blepharitis, and I wonder if there is any truth in this....
On the other hand it could be quite a good idea to get rid of eyelid veins from the point of view of stopping vascularisation of the area, and perhaps halting onset of ocular rosacea (people have IPL treatments for ocular rosacea). Mine unfortunately have mostly come back, so it wasn't even a very successful treatment....

Another thing to add to the mix is that it all started at exactly the same time I started to take metformin for my PCOS (polycystic ovary syndrome). Not that I've noticed it happening (in terms of my skin and hair) but metformin is supposed to reduce androgen production.....and I have read also that an androgen deficiency can cause blepharitis.....could this be what is causing my eye problem?

I would be so grateful for anyone's thoughts or ideas....

[Gretchen]

Hi -

It is highly unlikely that laser treatments on your eyelids caused your blepharitis. Many of us on this board get IPL (laser-like) treatments for our ocular rosacea induced blepharitis and it is actually very helpful. So I would not worry about having "caused" your blepharitis by the laser treatments.

It is more likely that you have an unfortunate confluence of factors (which many of us have) - a propensity for blepharitis because you have rosacea and the meds for your PCOS. I would look at these two culprits and go from there.

I hope that this makes you feel better.

Good luck
Gretchen

[redandunhappy]

Hi Gretchen,

Thanks so much for the reply and reassurance, it makes such a difference hearing other people's advice, so I really appreciate it.

I think I've pretty much come to the same conclusion myself, that the laser itself could not have caused it, and that I probably do have ocular rosacea.

But I'm interested that you seem to think the metformin medication may be playing a part. Funnily enough, my eyes have been much worse in the last few weeks - feeling sore all the time - and I have just increased the dose of my medication.

I wonder if it this is just a co-incidence.....I find it so hard to separate all the possible causes out.

Anyway, thanks again for your note.

[Gretchen]

R&H -

You can do many searches on androgen and dry eye. Androgen deficiency is a well established cause of dry eye - it has long been known that Sjogren's patients are androgen deficient and also dry eye is exacerbated in menopause when androgen (and other hormones too) drop off. Androgen has an effect on lacrimal glands, but I also believe that they play a part in the MGs as well. As I said, you may have an unfortunate confluence of issues - MGD from ocular rosacea (hence lipid deficiency) as well as a reduction in lacrimal output (hence aqueous deficiency) from a reduction of androgen. This combo would definitely pack a punch in my opinion.

As I mention, start with some research on ocular rosacea and then on androgen deficiency/dry eye. You will find a lot.

Good Luck,
Gretchen

[redandunhappy]

Hi there Gretchen

I've been trying to read as much as I can (without my eyes getting too sore) on androgen deficiency and dry eye.

It seems that there are mixed opinions about how significant androgen levels are to dry eye, so it's hard to know what is correct.
Ringo posted that:

"MGD ismostly a result of androgen deficiency, but interestingly (how does our body work!), this deficiency may or may not be present in the body overall, meaning that your body can be producing a suffcient amount of androgens verall, but somehow their concenration in the eye diminishes. Why that happens is a subject of a long and complex research which unfortunately I cnnot quote right now, but with dry eye, unless it is the result of a disease affecting the body overall like AIDS, Sjogren's, diabetes, etc., the androgen deficiency as the inflammation itself is localized and limited to the eye."

But interestingly, I've read on here about women who were taking androgen blocking contraceptive pills, then stopped taking the pill but nothing changed.
Does that back up what Ringo says or contradict it? - that if androgen deficiency is not a systemic thing in the body, then it's not relevant. Would you count women going through menopause as having a systemic deficiency in androgen levels as Ringo suggests?

And in my case, would medication which is supposed to decrease circulating testosterone make a difference to androgen levels in the eye? Would it make a systemic change?

Also, what is weird for me is that my androgen levels have never been low and in fact were above normal range before....By looking at my skin etc, since taking metformin they don't seem to have gone down - if they have come down at all, it's only been very slight and I bet they are still at the upper limit of the normal range....will soon know when I get the results of a recent blood test.

So I don't think I have an androgen deficiency in my body.....but perhaps I do in my eyes?!?

Hmm, how to get to the bottom of all this......

[Gretchen]

R&H -

Exactly how androgen levels affect dry eye is something for the PHD's to figure out. And they have been working on it, but to no avail. There have been at least one androgen eye drop that got caught in the pipeline...

The important thing is to understand that there may be a link. And possibly not just with your medication but also with PCOS. And of course if you have rosacea, then you can attribute a great part of this to ocular rosacea and begin by treating that.

Good luck.
Gretchen

[redandunhappy]

Thanks for your help again Gretchen.

You're right that we should leave it up to the experts to figure out exactly how androgen levels affect dry eye!
From what I've been reading androgens regulate the lacrimal gland and meibomian gland function, so it's quite complicated.

I would however like to at least understand the basic principles behind it....so I can make basic sense and work out whether it's worth stopping my medication - as it could be a complete red herring and then I would have stopped treating my PCOS. It's very tempting though - the thought that stopping it might solve my eye problems is a big pull (but an unrealistic outcome I suppose)

Chemia - you sound like you are in a similar boat - presumably you were taking a birth control pill with an androgen blocker in it? And interesting that you tried testosterone cream on the eye and it didn't help. So have you ruled out androgens playing any part for you?

[Robin21]

Erbium/ YAG laser damaged eyes?

I read w/interest the question regarding an eyelid laser treatment possibly damaging "redandunhappy's" eyes. I had a full-face skin treatment called Erbium YAG laser several years ago. The morning after the treatment (released from doc's office at 8 p.m. -- woke up at 5:30 the next a.m.), it felt as though my eyelids were stuck to my eyeballs. The doc who did the treatment dismissed my concerns. During the early stage, it was so painful and severe that I had to pry my eyes open w/the tip of the eye dropper to get the drops in. The problem affected me mostly at night. I went to numerous ophthalmologists who diagnosed severe dry eye syndrome, erosion, among other things (different for each doc). None were interested in the cause and just treated it as a progressive aging sort of condition. I'd never had any eye problems or dryness before, had had an eye check up a couple of months before w/no problems and this literally came up over night. The condition was horrendous at first and continued for many painful, sleepless months. So many different kinds of drops, gradual hopelessness that it would ever get better. There's been some improvement but not w/the drops, mostly because I run a humidifier around the clock and do all the wet rice bag types of things people talk about on the site. But still, every night and every morning dry & sticking. Anyway, "redandunhappy" your question was not so far-fetched and I sincerely hope you've had some improvement since April. Has anyone experienced this problem coming on like this or heard of it? Could it have been the laser? What else could it have been. Warm wishes to all of you!

[Robin21]

Hi all,

I have been recently diagnosed with blepharitis & MGD, and evaporative dry eye.

I have had mild rosacea for a number of years so I'm wondering whether I'm just finally sucuumbing to ocular rosacea. I do have a some new red veins in my eyes that I never used to have, and I've read (on this forum) that this is a sign of ocular rosacea.

However, there are some other possible causes that I'd really like to rule out first:

My problems started a few months after I had some laser treatment on my eyelids to get rid of the very prominent veins there (I suffer from mild rosacea on my face) and I wonder whether this laser treatment might have caused my blepharitis - does anyone have any thoughts about this? I hate the thought that I could have brought this horrible condition on myself.

.

I see that other readers have discounted the treatment; however, my dry eyes began at dawn the morning after an Erbium laser treatment for skin conditions which concluded at 8:30 the night before. Nothing else happened, just a drive home and sleep. As no doctor has been able to resolve this condition (after 3 years), I've been trying to find out what the treatment might have done to cause this in hopes of finding an appropriate treatment.

Having said that, I empathize with you and encourage you not to feel that "something you did" might have caused your condition. It just adds to the suffering. I hope that you're doing better and send warmest wishes.