Rosacea - Metronidazol Gel

[Sannah25]

It's been quite some time since I last visited these boards!

I started suffering from Blepharitis and MGD about 1,5 years ago now. I have since become convinced that the cause of my eye problems is in fact (ocular) rosacea. I started getting facial rosacea some 9 months ago and have learned that rosacea actually runs in the family: both my uncles have been dealing with this condition for a long time. Also, my eyes seem to get worse with regular warm / hot compresses.

My doctors do not believe in the link between the two diseases and still keep going on about baby shampoo lid scrubs despite my arguments. I have seen four different doctors and though they have been understanding and kind - and most of them agreed that I have both MGD and rosacea - they just refuse to acknowledge that the diseases may be connected. I have now been given a gel, Rozex (metronidazol) to treat my facial rosacea and they advise I continue lid scrubs. I have actually given up on them months ago and am controlling my eyes with eyedrops, occasional warm compresses, general hygiene and wipes called supranettes. It's not the best regime, and it hasn't significantly improved my eyes, but at least there have been no styes or any excessive burning.

I have two questions for you experienced people:

1) Can I use this gel on my eyelids? My current doctor does not recommend it, but also hasn't exactly forbidden it.

2) How do you treat your ocular rosacea? Is there anything I can try that does not involve antibiotics or other medication?

I know I should ask a doctor about this but I have given up on finding one in my country who is sufficiently knowledgeable in this area.

[littlemermaid]

Hi Sannah,

1) http://www.drugs.com/pro/metronidazole-gel.html I usually search on 'US FDA metronidazole' to look up prescription drug information and warnings. This Drugs.com link lists the Metronidazole gel, very bad near the eyes.

2) We are treating ocular rosacea in a similar way to you. Maintaining meibom by taking fish/flaxseed oil capsules, using daily warm compress flaxseed bag to keep things moving. LM has reinfecting meibomian glands from acne rosacea - we are using preservative free topical antibacterial ophthalmic drops as needed. We are not using lid hygiene detergents for fear of damaging oily layer of tear film or changing pH. The aim is to maintain healthy meibom. If we were not using antibacterial drops and warm steamy flannels I might consider wipes like you. She uses tear substitute drops >6/day, Celluvisc or Hycosan, tries to keep the environment good for the eyes eg wraparound sunglasses, humidifier.

On rosacea, we are also following http://rosacea-support.org/community/ for forums but particularly research update feed. Plenty of current information on metronidazole and other options there.

We've seen over 25 docs and had the same story as you... I wish the dermatologists and ophthalmologists and immunologists would all get together! The best diagnosis we had so far is to describe this as 'hypersensitivity'. For this reason we are looking at contact allergens, environmental and dietary triggers.

However, there is much research underway on dry eye and rosacea, allergy and immune response, which we are mostly following on PubMed and Medscape. If you like this, you could also set up Google alerts using keywords, or sign up for medical journal abstracts notification where the latest research is published. This way you would be more knowledgeable than most docs... but you could then work with any sympathetic docs you have. It's important to continue having checks with qualified ophthalmologists to look for eye surface damage, inflammation or vision changes, especially if your eyes are not comfortable.

Good luck Sannah. I think you're doing all the right things so far to look after your eyes, especially reading up here on dryeyetalk. Have you noticed rosacea flareups and what might be causing them? Love from London.