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**littlemermaid** · 10-May-2011, 03:21

dijon84: For this, we have tried - Head & Shoulders (new formula with Zinc Pyrithione), Nizoral 2% shampoo (ketaconazole), Neutrogena TGel shampoo. Prescribed scary Nizoral 2% cream (ketaconazole) but didn't fancy it because the problems were in what they call the Tzone - eyebrows, eyes, nose, also slightly red dry behind ears. I have to say, what I think got the MGs going again was the Head & Shoulders and there were no problems letting it over the face in the shower with a quick eyebrow rub. Also did good work on the yellow scaly skin. Hair soft and shiny. We used to use basic tea tree shampoo for the scalp, bit drying, but it never improved the MGs like Head & Shoulders. They should be paying me to promote the stuff as a miracle cure for sebaceous bleph with a possible fungal component (Malassezia).

3 little white bubbles

NB we need antibacterial drops/ointment as well to help clear the chalazia which form as the meibom chokes up, lots of warm steamy flannel compresses and gentle massage with the flannel (this is what Moorfields recommends for children). Failing that if we are in a rush, warm kettle water with cotton wool, separate for each eye. No skipping. Any tiny yellow flakes around lash line need to be cleaned off night and day. We find baby shampoo gives a red eye but you might be fine on it.

Taking the flaxseed/fish oils that improve meibom production have been a problem as sebaceous glands went into overdrive although oily fish is good. Still persisting with the low animal fat, low sugar diet, and this helps.

If you haven't found them yet and you still think it might be seb bleph, here are people who've made progress on seb derm although nobody says it's easy http://rosacea-support.org/community/

I am still thinking there's a good chance you might be aqueous deficient as well and this needs checking out. They should be giving you preservative-free bland eyedrops on prescription. Helping you to improvement is a great skill and I hope your hospital eye service comes good for you.

**dijon84** · 10-May-2011, 05:15

Littlemermaid - thanks for your detailed reply on this thread and the other thread that I started. Think I'll continue on this thread - the only information to bring over is the squint / strabismus that I have had since I was about 5 in my right eye (can only read the largest writing in that eye). Also, I have been eating oily fish or taking omega-3 supplements every day for the past month.

I went to the doctors today and showed him what I wrote in my first post. He agreed with the assessment of seborrheic blepharitis, and prescribed me the Nizoral 2% shampoo, and hydrocortizone cream to use on the area of skin between the eyes (I've had problems with the skin there and getting spots there for about a year). He described the 3 little white bubbles inside my lower left eyelid as 'prominent' rather than blocked and inflamed. He had a look in my upper eyelids (which I've not been able to do), and noted the redness and irritation (not necessarily blocked MG glands). There were bits of skin elsewhere on the eyelashes and eyelids also. He said I might be overdoing the massage a bit - need to find the balance between doing too much and too little.

At the moment, my symptoms are not too bad during the day (compared with what they used to be). Slight soreness in the upper eyelids and the heavy eyes feeling, as well as the slightly blurry vision / shortsightedness.

Will definitely go back to the opticians soon, and will get them to check out my tear film. Hopefully it is a tear film issue that can be resolved so won't need glasses long term.

**littlemermaid** · 10-May-2011, 05:59

the doctors

Is it the GP or hospital eye service? It is worrying that you are losing vision in your good eye and I am wondering if the optometrist shouldn't be making a referral for a good old checkup?

hydrocortizone

I would think twice about using steroid cream, especially if this was a GP prescription, especially if you already have MG problems, especially near the eyes. I still think my daughter's inflammation response was flipped by steroid cream on the face; there is a good incidence, esp in children. I think steroid cream would be justified locally for life-destroying dermatitis but they do tend to dish it out in the absence of another solution. Sorry to be so forceful - this is one of my personal nightmares. Hope your opticians are working hard for you!

**dijon84** · 11-May-2011, 04:56

It's my GP that I have been to see. Not been to the hospital eye service, although I am thinking I should go there too.

Thanks for the warning about the cream. My eyes feel a bit better this week, so perhaps I'll avoid using the cream for now. I'll add the Nizoral shampoo to my routine, and use the H&S anti-dandruff shampoo every day if possible, on the scalp and eyebrows.

There's still a few things that I'm confused about:
- Still don't know if I should be using eye drops or not, as I can get through most days without them. Don't want to go back to the days of using Viscotears every half hour. I'm sure I must have found that the more I used them, the more I needed them.
- With seborrheic blepharitis, one of the symptoms is greasy scales on lashes. I don't think I have this, although the bases of some of my eyelashes are now a whitish colour.
- I went for a skin consultation a few weeks ago as I have been having some spot problems over the past year. The conclusion was that I don't have particularly oily or spot-prone skin, and just need to cleanse and moisturise more, as well as drinking more water. So I don't know why it is just around my eyes that look and feel greasy. In the mornings, I'll have a shower then do my eye routine. After doing the warm compress for 5 minutes, this is when my eyes look and feel the most greasy.
- I think my blepharitis started as an infection, as I believe I used a contaminated towel on my face one night. The next morning there was lots of eye discharge and the foreign body sensation in my right eye only. The infection went to the left eye as well after two days. Then my symptoms have gradually changed to what they are now.
- I've had a dandruff problem for alot longer than I have had blepharitis I'm sure. A few years ago, I went through the phase of not washing my hair - after a while it takes care of itself if you don't use shampoo. So I didn't use shampoo for several years, although had a bit of dandruff - didn't seem a problem.

**littlemermaid** · 21-May-2011, 13:48

dijon84: Good to hear that your eyes feel a bit better. Sounds like blepharitis is improving with your new shower and eye routine. Nizoral is short-term, Head & Shoulders shampoo does a great job for us with milder ingredients that can wash over the face. We have had to accept that bleph comes back without the daily routine and very clean towels and pillowcases, although we can get away with a warm shower eye clean for speed sometimes, especially when the warm compress worsens inflammation.

The best way into the hospital eye service for you if you need it, to make sure your good eye is safe, would probably be through the optician. You have to make sure they are up-to-date - we saw several independent ones who trained too long ago and were not useful - the main high street ones were better on these conditions. They will try to sell you stuff you don't want, like more lid scrubs and drops.

I'm sure I must have found that the more I used them, the more I needed them.

We are using minimum drops, preservative free, according to need, to help the eyes to recover and avoid surface and tear production changes due to the drops.

**dijon84** · 22-May-2011, 07:05

Hi
Thanks for the reply. Sounds like I might be ok avoiding the eye drops when possible (haven't used them for two weeks). I'm going to write down all my thoughts over the past 11 days (it does help to write things down). If you don't want to read everything below, there's just a few things you might be able to help with:
- I've used the Nizoral shampoo every 3 days (used it 3 times in total so far), with Head & Shoulders on the other days. I'm not sure that the H&S is working yet as I'm still getting alot of dandruff - it's very small white flakes. Wondering if I should try a different anti-dandruff shampoo to H&S or keep going with the H&S.
- I don't really understand why the areas around my eyes look and feel greasy but the rest of the skin on my face isn't like this (it's dry and flaky if anything). I don't understand the connection with the dandruff and blepharitis either.
- Wondering if I should tone down the warm/cold compresses and massages. I don't feel particularly better after doing them, seems like my eyes are telling me to leave them alone. The bleph sometimes feels like it gets better throughout the day ie when I leave my eyes alone.

Things have been a bit up and down the past 11 days. The eyes felt worse the next few days after I last posted - a combination of too much beer, not enough sleep and some junk food (not sure which is the main contributor) I think.
Then I went away for a few days to Lundy Island (a remote island in the Bristol channel). At times when I was there, the eyes were uncomfortable, but the day after I came back, my eyes were probably the best they have been since I got this condition. In particular I've noticed it's not as bad when I've been trying to go to sleep. When I was on Lundy, there were so many changes to what I usually do throughout the day, I can't figure out exactly what caused the improvements.

Poss causes for improvements to the eyes while on Lundy - plenty of fresh sea air, spending more time outside than usual, plenty of walking (exercise), getting enough sleep, started using the Nizoral shampoo. I also changed my eye routine a bit, because the tap water on Lundy is suitable for drinking, but is slightly discoloured and has an unusual taste. So for the lid scrubs, instead of using water/baby shampoo then rinsing with water, I decided to just use a cup of cooled boiled water to do the lid scrubs (because I didn't want to be rinsing my eyes with that tap water).
There were also some possible causes for my eyes to worsen while I was on Lundy - too much beer, pub food every lunchtime and evening, it was very windy over there (debris blowing in eyes / drying the eyes out), I got sunburn/windburn on my face, and the tap water may not have been clean.

So the day after I came back (Wednesday), my eyes felt the best they have for ages. So I decided stop using the baby shampoo for lid cleaning and just use cooled boiled water for it. My eyes have probably been a bit worse each day since Wednesday - possible causes for this are not enough sleep on some nights, too much beer, some junk food, not as much exercise / sat in front of a computer again, and the sunburn on my face peeling.

So this is a bit of a ramble, but useful for me to write it all down!

**littlemermaid** · 22-May-2011, 13:13

dijon84: Hey, good to hear you had a great time on Lundy Island, what a fantastic place. This process you are going through is what we do too - working out what improves it, what makes it worse. I know the theory is to change one factor at a time, scientifically - but sometimes we just seem to have a great few weeks, then a bloomin' red eye flare-up, who knows why. The key for us has been strategies for dealing with flare-ups, and, like you, a maintenance regime, trying not to interfere when it's not needed. But this is not enough.

It would be great if you could find an optometrist you like in Cardiff who's interested in dry eye and MGD to check your eye surface, tear film and tear break-up time, have a look at your meibomian glands, help with assessment of inflammation around eyes. It's worrying you haven't been checked by a hospital ophthalmologist yet when you have had blurry vision and inflammation. Both these signs are criteria for referral and the optometrist would do it. Have you been able to see dots of oil along the lid margins? Have you had improvement with flaxseed/fish oils?

I don't really understand why the areas around my eyes look and feel greasy but the rest of the skin on my face isn't like this (it's dry and flaky if anything). I don't understand the connection with the dandruff and blepharitis either.

I am reading up on seborrheic dermatitis, but because aetiologies are different you might want to start with general derm/eye conditions to see what you recognise. http://www.modernmedicine.com/dermcounselor or http://dermnetnz.org/ and http://dermis.net/dermisroot/en/home/index.htm and Medscape, of course. Good to hear how you are getting on, still worried you need a hospital eye clinic ophthalmologist check!

**spmcc** · 22-May-2011, 14:22

My dermatologist told me years ago (when I was diagnosed with seb derm) to get a bunch of shampoos.

She told me to get one bottle of each of the active ingredients out there.

There's
*zinc pyrithione (e.g., H&S)
*tar
*selenium sulfide (e.g., selsun blue)
*salicylic acid (e.g., H&S has a product)
*ketoconazole

Cycle through them... one per day (don't skip days or use other shampoos)... also scrub/wash your eyebrows, behind your ears ("hot spot" for seb derm) and even your face with the suds.

At the very beginning (say, the first 2 weeks), if you can, bathe twice a day to get a good "kick start".

**dijon84** · 22-May-2011, 14:25

Thanks, yes Lundy is a fantastic place, loved being there. It is hard to work out exactly what causes improvements / deterioration, but will keep trying it. I've just had a look on the web for dry eye specialists in Cardiff and think I have found 2 - one conveniently works in the Cardiff University ophthamology department, which is on the road where I live! I'd thought about going there but thought the eye clinic would just be a regular opticians - but I really should have been there by now as I walk past it every day on the way to work.
I don't think my vision has been blurry the past week, but it has come back a bit today. Can't say I've noticed dots of oil on the lid margins. The main thing about the lid margins is the thickening and how the bases of my eyelashes on the upper eyelids are white. I've been taking fish oils for the past few weeks (except on Lundy as I forgot). They might have made a difference. Compared to what I was like a few months ago with putting in eyedrops every half hour, I haven't felt the need to put in eye drops for the past two weeks. Thanks for the links, will definitely check those out. Feel like I'm on the way to getting better but still some way to go.

**littlemermaid** · 22-May-2011, 14:41

dijon84: Hey, just sent you a PM on this very topic, dry eye docs in Cardiff.

That is good advice from spmcc - pretty much cleared the MGs for us using some of these, antibacterials were not enough, and now we are just on maintenance, tapering drops as far as possible.

Can't say I've noticed dots of oil on the lid margins

OK, what you're doing is checking your own meibomian glands in the bathroom mirror, in good daylight if poss. Use two fingers, push slightly upwards under lower lash line and hold lid margin away from eye surface. Look for tiny dots of oil along lid margin. See if you can see the tiny holes where the oil should be expressing. For the top eyelid, we pinch very gently with thumb and first finger, pulling lid carefully away from eye surface. Bit trickier but you will be able to lift the eyelid away to have a look at the lid margin. Normal oil looks clear, other gunk is what you're looking for. If you see nothing but your eyes are blurry afterwards for a while you have probably expressed meibom. If it's a bad day, we gently pinch on the lowers a bit after the warm compress to try to get things moving, or just give the eyes a bit of a rub. But not so as to make any inflammation worse.

**Angela** · 23-May-2011, 17:55

Originally posted by dijon84 View Post

I don't think I have this, although the bases of some of my eyelashes are now a whitish colour.

Hey, I have the same thing with the bases of my some of my eyelashes being white. The lashes look very dull and brittle and I have patches where some are missing.

Originally posted by dijon84 View Post

- I think my blepharitis started as an infection

I believe mine started as an infection too. First my eyes were very itchy, then I lost lashes. I was misdiagnosed so I went over a month without properly cleaning my eyes. Then all of a sudden there was crusting on my lashes. Then the thickened lid margin. Now my entire eyelids are swollen and very greasy with discharge.

Originally posted by dijon84 View Post

- I've had a dandruff problem for alot longer than I have had blepharitis I'm sure.

I also have dandruff. My dandruff started 3 months before the blepharitis/mgd.

Question. Are you supposed to use the Nizoral foam on your eyelids? I've heard of people doing this but it seems kind of scary...

My problem is oily skin. I think if I found out what was making me skin so oily (food, allergy, hormones) I would be able to figure out a better treatment plan for the MGD/Blep.

Have you had the eye doctor try to express your meibomian glands to see what type of oil comes out? Mine only produce mucus which I think is mainly being caused by the inflammation. The way you explained the big build up of pressure between the eyes and up to the middle of your forehead, I have the same exact thing. It feels like a cross between an occular and sinus headache. And my eyes feel very very heavy. I don't have problems with my eyeball itself, apart from the fact that my eyelid is swollen so it makes my eye look smaller. Do you feel that way?

**littlemermaid** · 24-May-2011, 03:01

Are you supposed to use the Nizoral foam on your eyelids

I wouldn't, maybe read up on the scary azole antifungals. Especially when eye surface is compromised during a flare-up. Mostly we let the foams wash over, eyes tight shut, then rinse off thoroughly in warm water before opening the eyes. That's why I feel safer with Zinc Pyrithione in Head & Shoulders for regular use. Coal tar, Neutrogena T/Gel, is harsh and poisonous and I didn't want it soaking into the eye surface. We have used all three just as spmcc describes, foaming over the face. LM's eyes are dry after so we use an eyedrop, probably because of detergent. We are also careful to preserve the eyes from detergents and perfumes because we are dealing with rosacea inflammation - vascular hypersensitivity, compromised skin barrier.

Was astounded that cradle cap disappeared first time and permanently with Neutrogena T/Gel - made me wonder about effect on sebaceous glands like MGs - maybe read up on Malassezia furfur, naturally occurring dermatophyte considered to be in overgrowth on sebaceous skin, for more info (Pityrosporum in older texts).

If it's more seb derm and seb bleph, I imagine there's less of an issue with contact allergens and you just have to keep it off the eye surface. A red eye would indicate it's not happy... We are super-careful around the eyes - we've got enough problems. We rinse in warm clean water very thoroughly to ensure no shampoo creeps onto eye surface off the skin during the day.

I have to say these anti-seb derm/dandruff shampoos left our hair really silky!

**dijon84** · 26-May-2011, 05:00

Angela: that is interesting that we have some of the same symptoms, but I've had a look at your other forum posts and there are some differences. What I get throughout the day now is very slight soreness in the upper eyelids (not as bad as it was), and a slight heavy eyes feeling around the upper eyelids. My lower lid margins are still enlarged but you'd have to look pretty closely to notice (again don't think it's as bad as it was).
The feeling I described of pressure in the middle of my forehead (only when trying to go to sleep) is not as bad as it was 2-3 weeks ago. In the past 4 weeks, I've only used eyedrops twice, and not for 2 and a half weeks now.Thinking about what might have made a difference:
- I have been using Nizoral shampoo twice a week for two weeks now, don't know if it has made a difference to my dandruff or not. I've been using it on my eyebrows but perhaps should I only use H&S on the eyebrows. For the days when I'm not using Nizoral, I used H&S instead. Will try some of the shampoos that spmcc mentioned.
- I've been trying to eat healthily (plenty of salad, veg and fruit), and drinking plenty of water throughout the day.
- For a month or more, I've been eating oily fish a few times a week, and taking omega-3 supplements on days when I haven't eaten oily fish.
- Trying to exercise where I can, mostly walking. My eyes do tend to feel better during exercise.
- Still doing my eyelid routine in the mornings and nights (see the top of the thread). I feel like something in my routine is not helping my eyelids, as they feel slightly worse straight after the routine and feel better throughout the day. Possibly the warm compress and overdoing the massage?

Hope that is some help for you.

littlemermaid: thanks for all your help. I've tried the steps you said for expressing the MG glands and didn't see any oil, although may not have been doing it right. Will look at the options for ophthamologists with a dry eye interest and book an appointment very soon. Thanks

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