steroid-induced rosacea from eye drops?

[y-gwair]

I'm seriously wondering if my current serious flare of facial rosacea was triggered by use of dexamesthane eye drops. I've gone through my records with a toothcomb; each time I've taken ophthalmic drops, my skin condition has flared and worsened within a couple of days. I would have been very sceptical that topical steroids could cause adverse symptoms beyond the eye, but now I'm coming to the conclusion that they have probably aggravated an existing skin condition.

When I initially saw my ophth, she said there was no MGD, just aqueous deficiency, and inflammation consistent with this sort of dryness. When this didn't resolve with plugs, she prescribed a month-long course of dexamesthane drops, which is when all manner of problems started.

mid jan - mid feb. Took dexamesthane drops, tapered over 5 weeks. Peri-orbital oedema/eyelid swelling started after a week. Finished course but 2 days after stopping noted 'itchy skin' in my personal record. Ophth. thought oedema was a reaction to preservatives, prescribed unpreserved version to use in case of another flare of corneal inflammation.

Beginning March - Tried unpreserved dex. drops for corneal redness/discomfort. Very bad reaction (worsened redness, pain, swelling), tapered them off over a week. MGs dried up almost completely in response, and a number were clearly infected. 3 days later noted 'terrible skin burning' in diary; a few days later the oedemic facial swelling started, has been constant since mid march

April 18 -GP prescribed 20 mg prednisone for facial oedema, took for 2 days (on premise that it might be allergic angioedmic swelling, which it wasn't); noticed definite worsening of skin flushing as effects wore off, affecting wider area of face than before.

May 27 - saw ophth. who confirmed there was now quite significant MDG, prescribed ciclosporin ointment.

June 11 -18 - ciclosporin prescription delayed for weeks, MGs had completely dried up so used dexamesthane drops again, tapered over 1 week as eye pain was terrible.

June 18 - sudden extreme face flushing and burning, serious neuralgic pain, still going on...

I know rosacea can sometimes present just in the eyes initially but I trust the word of my ophthalmologist (based at UKs leading eye hospital) that I didn't actually have it to begin with. Has anyone else noticed a worsening of cutaneous rosacea symptoms after treatment with ocular steroids?

[NeedMyEyes]

Steroids have only hurt me so far...

I have a confession to make:

Steroids have never done anything good for me. They have never made me less dry, never made me hurt less, never made me "feel better" like my optometrist said they would.

In fact, the lowest points I have had with this disease were while taking steroids... during the 2 months I took Tobradex, it dried me out horribly causing me to wake up several times at night to put in additional ointment.

Also, it was during this time that my upper eyelids began to swell and get very "veiny". I thought is was allergies to my eye drops, but it might have been something else. I guess I'll never know for sure, but it is definitely not going away.

The Tobradex also irritated my eyes soooo much when I put it in and throughout the day.

During this time, I broke up with my long term girlfriend and I tried to cry... but NO TEARS would come!! I thought my dry eyes were getting worse and worse in only 6 months of having this condition.

Finally, when I stopped the Tobradex after 2 months, approximately a 4 or 5 days later, my eyes just started making tears... I didn't know what was going on. They would make tears all day and I had to have a tissue to see well. Finally, my eyes were not only not dry anymore, they felt GREAT!! I was hoping it would last forever, but after a few weeks they stopped making tears.

Later I realized this was steroid rebound - I had stopped the Tobradex too quickly and should have tapered more slowly.

Since then, whenever I take Lotemax, Alrex, FML or any other steroid - I am dry in 2 or 3 days. I have heard of other people having these types of problems.

I don't know about rosacea though. I know that Dr. Latkany thinks steroids help most with rosacea. They certainly don't help me and I have finally decided to never take any steroid ever again.

[littlemermaid]

Ophthalmic topical steroid side effects: LM started pressure urticaria - dermatographism - on unpreserved Prednisolone eyedrops 2y ago. Assume it's systemic absorption, still occasionally recurs.

Now we pinch closed the puncta (tear drains) - punctal occlusion - for at least 15 secs after ALL drops. Particularly for steroid - need FML pulse therapy tapered for surface inflammation, chronic use - we always wipe skin around eyes with warm water cotton wool. Always drop into the lower lid pouch, not direct onto cornea. Possible surrounding skin and cornea thinning. Systemically, hoping to prevent adrenal interference. Docs never told us this stuff - US FDA. (I think I read - less absorption with ophth ointment base?)

LM's aetiology is probably steroid-induced periorificial (eyes, mouth, nose) paediatric rosacea induced by 28-day course of corticosteroid base Clotrimazole cream on prescription for minor skin complaint around hairline - never been confirmed by docs.

I'm still trying to understand how steroids/immunomodulators/NSAIDs imbalance the autoimmune response for some people. What is a genetic steroid responder? We know they control inflammation; not healing, I guess, unless they are giving the eyes opportunity to recover.

Also, NME, how all these chemicals we use change the eye surface which prompts for basal and reflex tears (Prof Christophe Baodouin and team), also osmolarity.

[y-gwair]

Also, it was during this time that my upper eyelids began to swell and get very "veiny". I thought is was allergies to my eye drops, but it might have been something else. I guess I'll never know for sure, but it is definitely not going away.
I don't know about rosacea though. I know that Dr. Latkany thinks steroids help most with rosacea. They certainly don't help me and I have finally decided to never take any steroid ever again.

Exactly the same as my experience. The swelling/peri-orbital oedema has now gone away, but only after a course of antibiotics to treat sinus infection, which seemed to follow on from inflammation that started the same time I had plugs/steroids (steroid-induced rhinitis, from contamination via tear ducts)? My ophth. said the same about steroids re. ocular rosacea and yet they definitely seemed to exacerbate MGD in my case (whilst seeming to have a positive effect on surface and the papilliary conjunctivitis which I think must have been quite bad).

My rheumatologist is very anti-steroids, says they all do far more harm than good, including topicals including nasal sprays (which she thinks should not be available 'over the counter').

There definitely seems to be some genetic component in drug/chemical sensitivity, as most of my family have hypersensitivity problems, even those who don't suffer from an autoimmune disease (my mother is similarly chemically sensitive, suffered and idiopathic urticaria / dermatographism which didn't respond to traditional antihistamene treatment for many years).