Would topical steroids make ocular rosacea worse?

[y-gwair]

Just started a second course of Dexamethasone to try to get on top of lid inflammation, and yet again the steroid drops have actually worsened the lid discomfort markedly (though work quickly to relieve discomfort/red veins on cornea). I have severe aqueous deficiency secondary to autoimmune problems, with papilliary conjunctivitis on upper lids but supposedly no significant blepharatis or MGD.

I know that oral steroids can cause imbalances of bacteria, am wondering if this could also be the case with the eye? Also that steroid creams exacerbate rosacea of the skin.

I have extremely sensitive, dry skin which is prone to flushing, lots of broken veins and recurrent acne-type redness on my chin, where the skin is now thickened and obviously scarred. I've never followed this up, it doesn't look like classic rosacea, but I did have a flare of very irritated skin around the same time my eye problem flared up severely last year. If the problems are related to rosacea, would steroids make the eye condition worse?

[hirentherock]

I have read on some sites that for ocular & facial rocesea , topical steriods is the only decent option to curb the rocesea.

I doubt the long term side effects of topical steriods..

[y-gwair]

Yes, but aren't those people are probably taking it in combination with systemic doxycycline or other A/B eye drops? I don't really understand what the relationship is between bacteria in rosascea/MGD, or whether the doxycycline works entirely via anti-inflammatory properties, or a combination of this and its ability to control bacteria that alter lipids, but there is definitely a correlation between taking the steroid and the lid irritation getting worse (but without irritating the cornea, which suggests it isn't a hyper-sensitivity issue as we'd previously thought).

[littlemermaid]

Hirentherock: Great to talk! Hope you are feeling good! I think Littlemermaid might have steroid-induced rosacea from using hydrocortisone cream for Tinea on the forehead and hairline. Certainly I am spending a lot of time reading about steroid-induced dermatitis. What if a switch has now been flicked to induce an inflammation response? And inflammation response to what? But yes, steroid creams have helped people with various dermatoses.

We still use steroid eyedrops to control the chronic eye inflammation, minimal.

Regarding controlling rosacea, we are having results on infected lesions with topical antibacterials and looks like no more chalazia (normal advice would be systemic antibiotics by now, we can't use them because of reactions) and trying pranayama breathing (yeh, I know, who'd have thought. I just gave in to those funky neurologists).

Lots of love, hope it's all going well.

[y-gwair]

Since yesterday lid margins have become very painful and red on upper lid, with enlarged, yellowish bumps where the meibomian glands openings should be, certainly wasn't like this a few days ago before I started the steroids again.

[littlemermaid]

Inflammation response to steroid

Y-gwair: Here is Dexamethosone info. http://www.accessdata.fda.gov/drugsa...023s025lbl.pdf 'Information for Patients: If inflammation or pain persists longer than 48 hours or becomes aggravated, the patient should be advised to discontinue use of the medication and consult a physician.'

Is it Maxitrol? Not sure why they're not giving you FML http://www.accessdata.fda.gov/drugsa...525S010lbl.pdf. Less to have a problem with.

If you think you might be a steroid responder, stop steroid drops and get intraocular pressure checked same day. If you've been on them for more than a few days you need help with tapering dose to avoid rebound inflammation. Or could be secondary infection as detailed. Or response to sulphates.

If MGs are infected do you have a topical antibacterial?

Do you think you might be able to get autologous serum in the long run? Any progress getting regular follow-up in a hospital eye clinic with an inflammation specialist?

[y-gwair]

Don't think it was due to raised IOP, as didn't respond at all last time I used them, fairly sure I'm not a 'steroid responder'.

Gradually stopped drops (unpreserved version of Maxidex) over last couple of days; the lid margin inflammation has gradually gone down, helped by hourly warm compresses. I'm sure it was triggered by the steroid as it came on so rapidly after starting them, and eased off in similar fashion on stepping down. Don't know whether it was infection, allergic reaction or some combination of both. Neither course of steroid has made any difference to lid pain that builds through the night.

[littlemermaid]

I thought you handled that rather well! Do you think lid inflammation is mainly anterior or posterior blepharitis or MGD or bacterial, or derm, or lacrimal? I am still trying to understand how steroids work.

[y-gwair]

I thought you handled that rather well! Do you think lid inflammation is mainly anterior or posterior blepharitis or MGD or bacterial, or derm, or lacrimal? I am still trying to understand how steroids work.

I wish I knew. No crusting on lids; meibum was thin and flowing quite freely until a couple of days ago (can usually express it easily on lower lids) but today seems to have dried completely, despite compresses and scrubbing with gentle soap today (facial skin particularly dry, flaky and irritated too).

Steroids worked well on vascularisation, even seemed to increase tear flow slightly, and apparently had a big effect on the papilliary changes last time round, but seemingly no impact on morning lid puffiness/soreness which makes me wonder if the cause is bacterial. Have emailed ophth. today, will see what she suggests.

[littlemermaid]

Yep, sounds like you're on the right track. See above, 'enlarged, yellowish bumps where the meibomian glands openings should be'

[y-gwair]

2 days with red face!

Don't know whether this was triggered by all the hot compressing but face has been flushing bright red and burning for last couple of days, so bad I couldn't stand it touching the pillow, eyes have also been terrible. Looking on Rosacea support forum, this does seem to be a common symptom of rosacea, along with temporary flushing and broken veins (which I also have in abundance over nose folds and cheeks).

Feel this might be a good point at which to perhaps see a dermatologist, as I feeling we might be reaching the limit of what the ophthalmologist can do. I realise in retrospect that I had a bad spell of this last autumn, just before the eye irritation started, but of course didn't make a connection.

Found and interesting thread on Rosacea Support, which suggests there may be a relationship between rosacea, facial skin burning and peripheral neuropathy. Other members of my family suffer terribly from these conditions (raynauds, burning extremities, severe intolerance of temperature extremes) which can be related to autoimmune disease and poor cholesterol metabolism, both of which I suffer from.

http://rosacea-support.org/community...hp?f=39&t=1029

[y-gwair]

Saw ophthalmologist today, asked her this. No, normally steroids work very well to control ocular rosacea, and she was perplexed by the symptoms I've been suffering and the adverse reaction to the steroid. Referred me to John Dart who specialises in inflammatory eye conditions, also local dermatology, suggested further rheumatological and thyroid antibody tests. Frustrating, but at least a couple of steps in the right direction, hopefully.

[y-gwair]

Roscaceous lymphedema

Eventually got to see a dermatologist today. She confirmed that I have mild facial rosacea, but thinks the eye/face swelling might be roscaceous lymphedema which isn't great news as there don't seem to be any effective treatments for it (which might explain why the steroids had no effect on it).