Any advice on a strange situation?

[Anthony16]

Hi guys,
i developed dry eye while taking accutane.(finished it like 16 months ago),and still have this eye inflammation.
However,my schirmers look ok(recently had a 6 in my left eye and 14 in my right-both anaesthetised).
A recent doctor i saw said my TBUT is around 10 seconds.
I then saw another doctor (who i had seen when i first got eye problems) and he said my eyes looked a lot better than they did back then.I went to him as i had an infection from the plugs that were inserted by the other doctor.
The plugs are not helping and my eyes still feel the same. Quite inflamed,aching,burning at times.
Could there be any other reason for eyeball inflammation other than pure dry eye?
Thnaks
Tony

[littlemermaid]

Hey dude, how are you? Just to let you know my teenage daughter is rosacea/dry eye, sounds like we're in the same boat here.

I am wondering if you still have MGD even though your aqueous sounds fine. Do you still have some acne? Canaliculi could have infected off that, bacteria very easily transferred in our experience. Same for meibomian glands - can you see any infection along the line? What do the docs say about your meibom production? Are you still taking fish oil, have you seen good meibom?

any other reason for eyeball inflammation other than pure dry eye?

Do you have a red eye as part of the inflammation?

Just wondering what Dr L is thinking about your MGs - he was talking about rosacea - any good ideas? We are thinking about immunomodulators. Have you got a derm? Wish you good comfort.

[Anthony16]

Yes,i definitely still have acne though its 65-70% better than before.
Last time i saw Dr Latkany he said my glands "dont look too bad",in that they were not atrophied,which he said was quite common in accutane patients like me.
i have normal looking eyes.Hopefully lid expression he showed me is helping.i will actually see him this wednesday so i hope he has decent news as i really need it
i will let u know how it goes
Im sorry to hear your daughter is in the same situation
i hope she finds relief
Thanks
A

Hey dude, how are you? Just to let you know my teenage daughter is rosacea/dry eye, sounds like we're in the same boat here.

I am wondering if you still have MGD even though your aqueous sounds fine. Do you still have some acne? Canaliculi could have infected off that, bacteria very easily transferred in our experience. Same for meibomian glands - can you see any infection along the line? What do the docs say about your meibom production? Are you still taking fish oil, have you seen good meibom?
Do you have a red eye as part of the inflammation?

Just wondering what Dr L is thinking about your MGs - he was talking about rosacea - any good ideas? We are thinking about immunomodulators. Have you got a derm? Wish you good comfort.

[y-gwair]

Last time i saw Dr Latkany he said my glands "dont look too bad",in that they were not atrophied,which he said was quite common in accutane patients like me.
i have normal looking eyes.

That's what I was told by an ophthalmologist at a leading specialist Eye hospital when she first saw me last autumn; that my glands weren't too bad, meibum was fluid and clear, easy to express from most glands, and yet I was having a lot of discomfort consistent with MGD. The discomfort also didn't improve with plugs. Latest visit a couple of weeks ago, MGD was more obvious, TBUT and staining poor in spite of increased Schirmer scores/tear volume. I guess even if the glands aren't atrophied, the chemistry of meibum might still be abnormal / pro-inflammatory.

[Anthony16]

I should clarify that he did say my glands were clogged and the quality of tear was not good but realatively compared to other people in similar positions(accutane),it was ok.
Anyway,im looking forward to my 7 hour flight to JFK(from ireland) on Monday.
Will let u know how it goes if u like
Thnx for ur reply
A

That's what I was told by an ophthalmologist at a leading specialist Eye hospital when she first saw me last autumn; that my glands weren't too bad, meibum was fluid and clear, easy to express from most glands, and yet I was having a lot of discomfort consistent with MGD. The discomfort also didn't improve with plugs. Latest visit a couple of weeks ago, MGD was more obvious, TBUT and staining poor in spite of increased Schirmer scores/tear volume. I guess even if the glands aren't atrophied, the chemistry of meibum might still be abnormal / pro-inflammatory.

[littlemermaid]

Will let u know how it goes if u like

Yes please, Anthony16. Love to hear what he is thinking about this. We hope it goes well for you.

[Anthony16]

Yes please, Anthony16. Love to hear what he is thinking about this. We hope it goes well for you.

Ok so,i had my appointment last Wednesday and it went fairly well.He said that when i saw him 6 months ago all my glands were clogged(though none were/are atrophied),and i produced 0 oil on a scale of 0-10.He said this is now at a 2(maybe 2.5) and he is pleased with this progress as my glands are severely dysfunctional(despite good TBUT results).
Also,Dr L said i have ocular rosacea(5 on a scale of 1-10).
He gave me an aspirin type eyedrop i think,also trying to get restasis compunded without the castor oil as i couldnt tolerate the normal restasis.Also,he said he wants my plugs removed as he doesnt think they are helping and may be making matters worse.
Dr Latkany was very nice and the best thing was that he thinks he can get me to a "functional" stage which wud be great.
Furtermore,I am now going to avoid all known rosacea triggers like the plague and see if it helps,as ocular rosacea is inflammation of the eyelids as well as eyes,so hopefully i can get more oil up.
he also said my lid margin looked "raw and inflamed".
Overall,i would say i would highly recommend him.1 month ago i was told by a local doctor my tear quality is fine but its really the opposite,so that will tell u all u need to know about the standard of care at home
Hope this helps someone
A

[littlemermaid]

Hope this helps someone

Oh yes, it sure does. Hope the flight was not awful. Getting you to 'functional stage' sounds wonderful. So glad to hear the MGs are making progress.

I wonder what Dr L thinks 'ocular rosacea' actually is? I think he is suggesting allergy testing sometimes to see if it helps track down rosacea inflammation triggers but since it's probably non-obvious maybe we'll have to work on this ourselves, as you say. http://www.dryeyezone.com/talk/showt...kany#post62249

Do you want to tell us what the aspirin-type eyedrop is? This is something new.

Wonderful that you can get compounded Restasis.

'Raw and inflamed' lid margins not so good, so sorry. We have good TBUT 10-12, MGs are improved now, no bacterial infection - but red dry eye surface. She did not use retinoids, acne is controlled. Similar to you eh? What the heck is this.

Bless you for sharing this stuff, that's a whole load of good karma coming your way. Wish you very good progress, Tony. Are you checking out Rosacea Support?

[Anthony16]

Oh yes, it sure does. Hope the flight was not awful. Getting you to 'functional stage' sounds wonderful. So glad to hear the MGs are making progress.

I wonder what Dr L thinks 'ocular rosacea' actually is? I think he is suggesting allergy testing sometimes to see if it helps track down rosacea inflammation triggers but since it's probably non-obvious maybe we'll have to work on this ourselves, as you say. http://www.dryeyezone.com/talk/showt...kany#post62249

Do you want to tell us what the aspirin-type eyedrop is? This is something new.

Wonderful that you can get compounded Restasis.

'Raw and inflamed' lid margins not so good, so sorry. We have good TBUT 10-12, MGs are improved now, no bacterial infection - but red dry eye surface. She did not use retinoids, acne is controlled. Similar to you eh? What the heck is this.

Bless you for sharing this stuff, that's a whole load of good karma coming your way. Wish you very good progress, Tony. Are you checking out Rosacea Support?

I think its called Nevanac.He just gave me samples as he wants to see if it works before i spend money on it.
I took a retinoid(accutane),so thats definitely my cause.
Are her lacrimals functioning ok?Does her doctor actually check the glands or just use TBUT?There was a big difference in my case
Im not sure exactly what he thinks it is and seems difficult to identify.But it causes MGD and eye inflammation.
Will look into rosacea support,to help find triggers.
Cheers
A

[littlemermaid]

Samples of Nevanac: he is kind, isn't he? Looks like Nepafenac, post-cataract surgery drop, might be available NHS if you could convince someone.

Accutane: good news that your MGs have some function again though, doing something very right. I thought LM was atrophied but we just kept going for years with cleaning and warm compress gentle massage, leaving it alone on flare-up days, much better now.

Lacrimals: that's the question, isn't it? We check the MGs and look at lid margins ourselves so not so reliant on docs these days. TBUT, they said, is good now. But, eye surface is still flaring up dry and red occasionally for no obvious reason as if it's hypersensitivity on the surface, can't see any lid margin probs. So, yes indeed. Good you have lacrimal function -a doc was telling me they had some aqueous-deficient patients on Accutane who picked up again after a while.

Cheers to you ~ and thanks.