Bacterial MGD.

[Angela]

Hey guys. I recently went for a sinus culture due to the severe headaches and congestion that I've had since 4 months ago when, you guessed it, my eye problems also began. Just like most of you, I've been to countless doctors and specialists hoping to find the culprit. I had seen an ENT a couple of months back who told me that he believed I had an acid reflux problem after seeing some evidence of erosion. I decided to go back to him last week after Dr. Latkany suggested I get a culture. I went to his office yesterday for the results and it turns out that I have a heavy growth of Staph Aeurus. In the beginning, all I had was eyelash loss. I was on FML for 10 days and then didn't do anything for a month. The next thing I was on was Erythromycin ointment which, according to my culture results, S.Aeurus is resistant to. Shortly after this my sinus problems began and I developed the intense frontal headache that is chronic and has not went away since. A friend of mine who knows about this stuff has suggested that I initially contracted the bacteria in my eyes (there are MANY possible ways that could have happened in my case), and then it traveled to my sinuses by way of the nasolacrimal duct. This whole thing has been a wild goose chase and I am just trying to figure out the connection and if there is a way to get myself to a comfortable place where I am not in constant pain.

Have any of you had any experience with this bacteria? I am still doing research on it but I know it is one of the main pathogens in bacterial bleph and mgd, so I can't NOT think that the sinus and eye issues just coincidently started at the same time and are both chronic.

The ENT prescribed 10 days of Avelox to knock out the bacteria systemically but I wonder if it would do anything to the MG's, assuming they're also affected by it?
Also, I was on Doxy on and off for a couple of months and the list of antibiotics suggests S.Aeurus is susceptible to Tetracyclines...so that's troubling.

[dijon84]

Sorry I can't really help regarding staph aureus but I'm interested in what you've said here. I remember some time ago you posted that you had some similar symptoms to me. In the past month, I've started getting frontal headaches during the day sometimes. I wouldn't say they are bad but some are uncomfortable. During the last visit to the doctor I was so focused on eye issues that I didn't mention these. I'm going back to the doctors next week and will mention it then. The feeling I get is an increase in pressure around my eye areas (rather than a throbbing headache), from behind the middle of my nose to the middle of my forehead, and it extends to near my temples (I don't think the sinuses extend to here do they?). Is that the sort of feeling that you've been getting?

[y-gwair]

A friend of mine who knows about this stuff has suggested that I initially contracted the bacteria in my eyes (there are MANY possible ways that could have happened in my case), and then it traveled to my sinuses by way of the nasolacrimal duct. This whole thing has been a wild goose chase and I am just trying to figure out the connection and if there is a way to get myself to a comfortable place where I am not in constant pain.

That's very interesting, I also developed a sinus problem around the same time as my eye symptoms worsened and both seemed to worsen in parallel with fitting of plugs, subsequent course of steroid eye drops.

The initial symptoms were blocked nosed/puffy eyelids which rapidly progressed to full-blown periorbital oedema, deep eye pain, conjunctival oedema and streaming sinuses with streaks of blood. Pain eventually spread to cheek/jaw area, at which point it dawned on me that some of the eye symptoms might be sinus-related. GP prescribed amoxycillin which cleared the peri-orbital oedema, bleeding and acute pain fairly rapidly. Ophth. confirmed these eye symptoms were likely to be sinus-related, and recommended referral to ENT and CT scan to assess what may be going on. The acute symptoms have subsided but they still feel blocked at times. I am sure there is a definite connection between the sinus irritation/infection and the eye condition (which seems to have improved markedly after starting to use an anti-bacterial eye rinse), I'm also suspicious about whether the steroids may have triggered some of these problems ( as I've also developed severe cutaneous rosacea at the same time, which can be induced by steroid use).

[Angela]

Sorry I can't really help regarding staph aureus but I'm interested in what you've said here. I remember some time ago you posted that you had some similar symptoms to me. In the past month, I've started getting frontal headaches during the day sometimes. I wouldn't say they are bad but some are uncomfortable. During the last visit to the doctor I was so focused on eye issues that I didn't mention these. I'm going back to the doctors next week and will mention it then. The feeling I get is an increase in pressure around my eye areas (rather than a throbbing headache), from behind the middle of my nose to the middle of my forehead, and it extends to near my temples (I don't think the sinuses extend to here do they?). Is that the sort of feeling that you've been getting?

Hey, sorry it took me so long to write back, I've been trying to limit my computer use as I've now developed dry eye on top of the MGD and Blepharitis and it's pretty severe in my right eye. :/

As for the headaches, the ones you've described do sound just like mine, they're pressure headaches. In my case though, I feel it it goes hand in hand with the congestion that I've got in my nose. Here's another oddity, my right nostril is more congested than my left, while my right eye is more swollen/dry than my left. Also, Dr. Kamat in PA told me that my MG's are more plugged up than my left. It's possible that these are all coincidences but I'd like to think not. As far as the sinuses extending to the temples, I don't think they do but I think that when there is pain and swelling in one area (let's say it's the frontal and ethmoid sinuses) it can cause the pain to extend a bit. Before I got this culture taken, every eye doctor told me that the headaches I am experiencing are not typical for dry eye. They said that while people sometimes get ocular headaches, the type that I described is likely being caused by something else.

[Angela]

That's very interesting, I also developed a sinus problem around the same time as my eye symptoms worsened and both seemed to worsen in parallel with fitting of plugs, subsequent course of steroid eye drops.

The initial symptoms were blocked nosed/puffy eyelids which rapidly progressed to full-blown periorbital oedema, deep eye pain, conjunctival oedema and streaming sinuses with streaks of blood. Pain eventually spread to cheek/jaw area, at which point it dawned on me that some of the eye symptoms might be sinus-related. GP prescribed amoxycillin which cleared the peri-orbital oedema, bleeding and acute pain fairly rapidly. Ophth. confirmed these eye symptoms were likely to be sinus-related, and recommended referral to ENT and CT scan to assess what may be going on. The acute symptoms have subsided but they still feel blocked at times. I am sure there is a definite connection between the sinus irritation/infection and the eye condition (which seems to have improved markedly after starting to use an anti-bacterial eye rinse), I'm also suspicious about whether the steroids may have triggered some of these problems ( as I've also developed severe cutaneous rosacea at the same time, which can be induced by steroid use).

Hi, thank you for writing back. I've seen posts of yours and in one of them you posted a picture of your eyelids and I thought my swelling/thickened eyelids looked similar to yours. When you went to the ENT, did they do a culture? I was on Amoxicillin as well a few months ago, Augmentin to be more specific, and it didn't do anything for me. On my culture results it says that Staph Aeurus is resistant to penicillins. But it did say it was susceptible to tetracyclines, and I was on Doxy on and off for 2 months which is puzzling. I'm on day 5 of Avelox now (the prescribed course is 10 days), and have only noticed a slight reduction in my headaches/congestion. Can I ask what anti-bacterial eye wash you use? Also, are your eyes still puffy? It's interesting what you've said about the steroids inducing rosacea, because my eye conditioned worsened after using FML both times (10 days each time), and Tobradex for a month. Also, after IPL with doctor Kamat, I used Lotemax and the third day I woke up with my right eye on fire and huge red veins on the whites of my eyes. It's been burning ever since.

One more thing that I'm freaking out about is that I've got these itchy red sore type things on my scalp and was reading that staph aeurus can cause folliculitis which seems to be what I have. =/ I see Dr. Latkany in a few hours so I'll be bringing all of this up at my appointment.

[littlemermaid]

Angela: Our brave woman in NY. How did you get on?

Your Staph sinus and eye infections were unresolved on Augmentin and doxycycline (was this dose too low, for MGD?). You've been on Avelox (fluoroquinolone) for 10 days. Has it cleared the sinus and eye infection? Just wondering what Dr L would do now? Still confused as to why ophthalmologists wash their hands of systemic infection.

[dijon84]

Hey, sorry it took me so long to write back, I've been trying to limit my computer use as I've now developed dry eye on top of the MGD and Blepharitis and it's pretty severe in my right eye. :/

As for the headaches, the ones you've described do sound just like mine, they're pressure headaches. In my case though, I feel it it goes hand in hand with the congestion that I've got in my nose. Here's another oddity, my right nostril is more congested than my left, while my right eye is more swollen/dry than my left. Also, Dr. Kamat in PA told me that my MG's are more plugged up than my left. It's possible that these are all coincidences but I'd like to think not. As far as the sinuses extending to the temples, I don't think they do but I think that when there is pain and swelling in one area (let's say it's the frontal and ethmoid sinuses) it can cause the pain to extend a bit. Before I got this culture taken, every eye doctor told me that the headaches I am experiencing are not typical for dry eye. They said that while people sometimes get ocular headaches, the type that I described is likely being caused by something else.

Hi - thanks for the reply. I saw the doctor last week about my these frontal headaches and he thought it was allergy related, so he told me to take anti-histamine tablets and use mometasone nasal spray each day. It'll be a few weeks until I can tell if these are having a positive effect or not.. Like you, my frontal headaches must be related to
my eye problems - they started 8 days after my eye infection did (this was in late February). I am thinking that if I am allergic to anything, it's probably the bacteria / yeast infections that I think I still have - I'm still getting eye mucus and greasy skin around the eyes and eyelids. Sorry - don't mean to take up your forum post but thought I'd reply here. Hope you're doing better with your sinuses.

[Angela]

Hi - thanks for the reply. I saw the doctor last week about my these frontal headaches and he thought it was allergy related, so he told me to take anti-histamine tablets and use mometasone nasal spray each day. It'll be a few weeks until I can tell if these are having a positive effect or not.. Like you, my frontal headaches must be related to
my eye problems - they started 8 days after my eye infection did (this was in late February). I am thinking that if I am allergic to anything, it's probably the bacteria / yeast infections that I think I still have - I'm still getting eye mucus and greasy skin around the eyes and eyelids. Sorry - don't mean to take up your forum post but thought I'd reply here. Hope you're doing better with your sinuses.

I've pretty much been given the allergy diagnosis from every doctor as well. I've tried Claritin D on and off with minimal relief. Also, it gives me an anxious feeling as well as extreme dry mouth which isn't the greatest. I use Nasonex nasal spray each day which does slightly help with the congestion, but not the headaches. My eye problems started in late February as well, I can't believe it's been this long already :/. Can you elaborate a bit more on your bacteria/yeast infections that you have? I will go through your posts as well to see if you've written about it. I have suspected I have a yeast problem in addition to the staph, I have frequent yeast infections (sorry if it's too much info) and lately I've been noticing white particles in my urine (again, sorry if too much info). I have yet to get a urinalysis to see what that's all about, due to no insurance. The last time I visited a GP and asked for a yeast test he told me that it was a "myth" and that I don't have a yeast problem. Well he is also the one who let me believe this was all allergy related when I turned out to have MGD, Blepharitis, and a heavy growth of staph. As far as the eye mucus, I still have that too. I actually just went for my second IPL treatment yesterday and have had tons of yellow discharge coming out of the corners of my eyes as well as some from my nose as well. This whole thing is really a mystery. I'm also considering seeing a guy who specializes in the eradication of demodex mites, as I've heard they could have a lot to do with bacterial/staph in addition to rosacea.

[Angela]

Angela: Our brave woman in NY. How did you get on?

Your Staph sinus and eye infections were unresolved on Augmentin and doxycycline (was this dose too low, for MGD?). You've been on Avelox (fluoroquinolone) for 10 days. Has it cleared the sinus and eye infection? Just wondering what Dr L would do now? Still confused as to why ophthalmologists wash their hands of systemic infection.

Hey there, how is LM? Yes, I was on the typical dose of Augmentin for sinusitis (750 mg I think..) for a week with no relief of symptoms and obviously no elimination of the staph which I didn't even know I had at the time. As far as the Doxy, I believe I was only on the antibiotic dose of 100 mg 2X daily for 1 week. And after that I was on and off 100 mg per day. I was on the Avelox for 10 days and while my headaches are slightly better, they are still there. I also still have significant congestion in my nose as well as thick white and sometimes yellow discharge. For my blepharitis/suspected staph eye infection, Dr. L prescribed Vigamox (same thing as Avelox in eye drop form) for 7 days which I finished today. The only noticeable difference is that my eyes are a bit less itchy. I had an IPL treatment yesterday and was prescribed Tobradex ST eyedrop so I'll see what happens with this. I am hoping that my glands are a bit more open now and that the medicine will penetrate a bit better. I'm not sure if I mentioned this in one of my posts, but when I saw Dr. L last week he told me that my blepharitis is an 8.5-9 on a scale from 1-10. He told me that I'm always going to have it and that the thickening of the skin on my eyelids is permanent. I started to lose a lot of hope after this. I don't quite understand. I've found out that what I have is 100% bacterial related, aren't antibiotics supposed to get rid of bacteria?

[littlemermaid]

Angela: Hey. LM is pretty good these days, thanks. We've got clear meibom at last after 3y of misery, good lid margins controlled with preservative-free antibacterial drops, we are tapering these and steroid, but not enough tear film yet though.

I was thinking, you had cystic acne and have been sebaceous around the eyes, and you're reinfecting. LM's MGs were hopelessly reinfecting off acne rosacea until we used Dermol 500 as a face wash (benzalkonium chloride, chlorhexadine). Not near the eyes though, but it has improved the MGs. Maybe not for you, this specific one, because you were thinking you had allergic inflammation after some drops with preservatives(?) Also, obviously, BAK to be avoided. Assuming it's Staph but never been swabbed. We also tried Bactroban inside the nose because this is where Staph is supposed to hang out, which didn't seem to do anything. Also got Duac (clindamycin, benzoyl peroxide) to try. Also used Fucidin (fucidic acid), fantastic at clearing skin infection fast. Also used Fucithalmic on lid margins.

I know you don't have so much acne now and that your infection is ENT but just wondering if a prescription antibacterial face wash might help if you do. Are you still using a dandruff shampoo? any luck with that? Also wondering why no warm compresses when IPL is helping? Have you moved out of the apartment now, so you know it isn't inhaling mould spores? I think you had an eyebrow piercing didn't you ma'am, just wondering if you wish to declare any more..?

There is something weird about why your oral antibiotic prescriptions aren't clearing the infections, isn't there? What are these ENTs doing, eh? I'm also wondering whether you're eating well, and can get a holiday with a bit of fresh air? Big hug from LM and I.

[Angela]

That is WONDERFUL to hear. Her lid margins are back to normal? My lids are still very much inflamed, with veins all over and the margins are still thick with prominent pimple like bumps all along the ridges. Clear meibum is what I am shooting for as I think my main problem stems from bacteria/inflammation which causes the "wrong" kind of oil. My oil is more like mucus and is sometimes yellow which suggests bacteria. I have not heard of Dermol 500 but I will look into it. I do believe that I had a bad reaction to FML ointment despite what everyone keeps telling me about it being near impossible to be allergic to FML. Either way, it certainly didn't make matters better and I've tried it twice, each time for 10 days. As for drops, after my first IPL I was prescribed Lotemax for the 5 days following. It burned my eyes something fierce and one morning I woke up and my eyes were bloodshot. I now have several large red veins on the whites of my eyes that I was told by Dr. Latkany are permanent. I've no idea if the Lotemax caused this for me but I will avoid it regardless because I have no way of knowing and these veins are painful...especially when I wash my face, shower, or first thing in the morning.

By the way, Duac is one of my favorite topical acne meds. I am a great responder to benzoyl peroxide and the antibiotic in the cream was a plus. I actually still use Proactiv face wash which is benzoyl. I have heard of fucidic acid but can't remember what it is used for? Is it an eyedrop or ointment? I feel I really need some good antibacterial since I now KNOW what I am dealing with. What type of prescription antibacterial face washes do you recommend that they have in the US?

I really want to get to the bottom of all of this because I can't accept the thought of having unrelenting blepharitis for the rest of my life. Yes, I'm still using dandruff shampoos, I use Neutrogena T-gel shampoo and alternate with Head N Shoulders. I can't let any of this stuff get near my eyes though, because even water stings and burns. As for the warm compresses, Dr. Latkany told me that if I really wanted to do warm compresses, to limit them to once a day and follow it with ice. To be completely honest, before the warm compresses in the beginning of all this..ALL I had was eyelash loss. I believe the warm compresses contributed to the inflammation. I also think that it helped bacteria grow in my case. I know they help immensely for others though, so I'm not knocking them!

I am still in the process of moving out of my apartment. I moved most of my stuff into storage and am waiting to find a place for my dog which is why I'm still here. Yeah I'm still inhaling this stuff. Additionally, today my entire bathtub filled with EXTREMELY rusty water and particles so I know there are issues in this building.

Eyebrow piercing yes. But haven't had that or my tongue piercing in years. The most recent piercings that I've removed are my labret, nose, and belly. I still have a few others but none are problematic as far as I know.

I agree with there being something weird with my non response to oral antibiotics. The only one I was on multiple times is Doxycycline. I was on Doryx (doxy) for acne before Accutane well over 2 years ago for one month. And I know I've been on it before at different times in my life. The Augmentin is penicillin which I have also been on several times but I think the reason it didn't work is because the staph is resistant to it. In fact, my culture did say it was resistant to penicillin. Avelox though..I've never been on a floroquinolone, and staph is supposed to be VERY susceptible to it. It's scary. I will make a new appointment with the ENT soon to follow up and possibly do another culture to see if the growth is still "heavy". I believe it is as I still have the symptoms.

I'm seeing a GP tomorrow. I will be asking for a urinalysis and a test for H.Pylori as I was diagnosed with gastritis a few years back and have been reading posts on this board about H.Pylori being a link to MGD.

Eating well? To be 100% honest, no I'm not. I'm constantly stressed and often have no appetite at all. I've lost 15+ lbs. I even had to buy those Ensure supplemental drinks so I don't become emaciated. I would love a holiday!

[littlemermaid]

Angela: Sounds like you're well on the job ~ knowing what's been helpful, what's made it worse. Interesting that all this started on FML, wonder if you're allergic to components of various drops and antibacterials. Any chance you're allergic to nickel? Just wondering if you could ask the GP about nutrition - what multivitamins and minerals would be helpful and not contraindicated with oral antibacterials you're on.

Are you a chicken and vegetable soup girl, or fresh chopped dressed salad with wholemeal bread, maybe Italian suits you? Maybe some vit C? In UK we are finally discovering the smoothie, fruit/veg. My understanding of diet/health/metabolism is zero, esp the more I try to read up... delicious food like veg kebab and tasty rice has to make you feel better tho'. It's difficult to coax yourself back to health when you're not feeling so well but docs only look at part of the story, bless 'em. Hope your GP's good today.

[y-gwair]

When you went to the ENT, did they do a culture? I was on Amoxicillin as well a few months ago, Augmentin to be more specific, and it didn't do anything for me... Also, are your eyes still puffy? It's interesting what you've said about the steroids inducing rosacea, because my eye conditioned worsened after using FML both times (10 days each time)

I haven't been referred yet (long story), and no one has mentioned a culture. The sinus infection/eye swelling actually got much worse the month I was taking lymecycline, though did clear rapidly with the amoxycillin. One eyelid is still slightly puffy in one corner, but nothing like before. However, my lashes are still falling out continuously, and seem to be getting smaller/thinner all the time. I have bald gaps on on the lower lid, and a couple of the ones that are left have become ingrowing. Is there a known link between bacterial MGD and lash loss? (wondering if ciclosporin may be accelerating this, apparently it can cause hair loss when used in dogs).

I once used fucithalmic when my eyes were horribly gritty years ago, at the time it was the only thing that made them comfortable at that time, which makes me wonder if there is a bacterial component to my problems as well. The lid wash is Sterilid - it does sting a bit but at least it does seem to help, unlike all the messing around with cotton buds/baby shampoo.

Forgot to add, the second time I used steroid drops, the glands all dried up and a number appeared to be infected (yellow blobby look, with redness/swelling around the area) and only unblocked with lots of compressing after immediately stopping steroids. This is the only time I've ever had anything like this, if they became infected I'm sure it was directly linked to the steroid drops.

[dijon84]

I've pretty much been given the allergy diagnosis from every doctor as well. I've tried Claritin D on and off with minimal relief. Also, it gives me an anxious feeling as well as extreme dry mouth which isn't the greatest. I use Nasonex nasal spray each day which does slightly help with the congestion, but not the headaches. My eye problems started in late February as well, I can't believe it's been this long already :/. Can you elaborate a bit more on your bacteria/yeast infections that you have? I will go through your posts as well to see if you've written about it. I have suspected I have a yeast problem in addition to the staph, I have frequent yeast infections (sorry if it's too much info) and lately I've been noticing white particles in my urine (again, sorry if too much info). I have yet to get a urinalysis to see what that's all about, due to no insurance. The last time I visited a GP and asked for a yeast test he told me that it was a "myth" and that I don't have a yeast problem. Well he is also the one who let me believe this was all allergy related when I turned out to have MGD, Blepharitis, and a heavy growth of staph. As far as the eye mucus, I still have that too. I actually just went for my second IPL treatment yesterday and have had tons of yellow discharge coming out of the corners of my eyes as well as some from my nose as well. This whole thing is really a mystery. I'm also considering seeing a guy who specializes in the eradication of demodex mites, as I've heard they could have a lot to do with bacterial/staph in addition to rosacea.

Hi - I don't know for sure that I do still have a bacteria infection or yeast infections. What I do know is the chain of events and how it surely must all be related.
13 Feb - woke up with foreign body sensation in my right eye and lots of eye mucus from that eye. Thought it was just a foreign body at the time but looking back I am almost entirely sure that it was due to wiping my face with a towel that wasn't mine the previous night (I was away from home and staying in a church hall - anyone could have been using that towel) - some sort of infection
14 Feb pm - foreign body sensation went to my left eye too.
20 Feb - this is when I started getting the frontal headaches at night, after closing my eyes to try to go to sleep.
The past month, I've started getting the frontal headaches on and off throughout the day.
When reading about seborrheic blepharitis, I read that the greasiness of eyelids is due to an allergy to yeast on the skin. It's just my eyelids that are greasy - I don't have particularly oily skin, according to a recent skin care consultation. I have been using anti-fungal shampoos the past few months (Nizoral, Selsun), as well as my regular shampoo - letting the suds go over my eyebrows and eyelids too. Not sure what effect that has had.
Thanks for the info about the nasal spray, I'll see if it has the same effect when I'm using it. I hope the nasal spray and anti-histamines will work for me, but I just have the feeling that they won't because they aren't dealing with the underlying problems. I get the impression from my doctor that he thinks I have an everyday allergy (eg hayfever or dust), but I'm not sure it is - thinking about the chain of events.

[y-gwair]

Just found this on rosacea support - some interesting thoughts on rosacea, staph. and tetracyclines:

Bacterial MGD/rosacea