Dermatologist or Opthamologist?

[kandykane1544]

Hey everybody,
The other day I posted about my speculation that I have ocular rosacea. I don't know if any of you have heard of Dr. Nase, but I read his book and he has some great advice on possible medications that have been proven to help rosacea patients. However, last time I was with my ophthamologist I asked whether it could be rosacea and he just goes, "it could be" (like every other possible cause I mentioned). He doesn't seem interested in trying to find a more accurate diagnosis. I'm not saying he's a bad doctor, he is a very good one. But to him, his job is treating the symptoms and after that, well, it's basically on me to make a move.
Anyway, what I was wondering is do you guys think I should go to a dermatologist instead? I am confident I will be plenty convincing, and after hearing my story and symptoms I think he'd be willing to prescribe medication (hoping for oracea, but Dr. Nase has other interesting suggestions as well that I will discuss with him). I have Dr. Nase's book bookmarked, highlighted and everything haha so I will be plenty prepared. As I mentioned earlier I am only home for one business day, and I just don't want to come back to college empty handed. There are meds out there that I might greatly benefit from and for the sake of my eyes the sooner I start the better. Thanks!

[kandykane1544]

Oh I forgot to mention. As of now, I have an appointment scheduled with my opthamologist in the morning and I am also scheduled for a lipi flow evaluation in the mid afternoon. I'm thinking about cancelling my opth appointment, seeing a derm instead, and then going ahead with the lipiflow.

[hankm9]

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[spmcc]

A dermatologist appointment is a great idea if you think you have rosacea. A derm can prescribe doxycycline (e.g., Oracea), but an ophthalmologist can/does also.

Nase's book is an excellent literature review. Of course, my copy is old (from 2001). It's also highlighted, written in, dog-eared, and post-it-ed (huh? - that's not a word!). I don't know if he's kept up with the literature, but if he has, it's a good source of published research on rosacea (incl ocular rosacea).

I also really like Frank Powell's book called Rosacea Diagnosis and Management (2009). Here is a review:
http://rosacea-support.org/book-revi...-c-powell.html

Regarding LipiFlow: My first LipiFlow in Toronto (July 2011) was great - I didn't have any rosacea flush/flare either during or after. The folks in Toronto had already performed hundreds of treatments - they were pros. My second LipiFlow in Richmond BC (Nov 2011) didn't go as smoothly - I did have a rosacea flush/flare. But they were newbies - had only done a couple of people.

I recommend LipiFlow now (esp to people like me with rosacea and MGD who can't do warm compresses). But I personally believe that LipiFlow only works after you've taken care of any aqueous problem.

So I would make sure you've had a thorough exam and know your "levels" of AD versus MGD. You don't want to waste money on LipiFlow if it doesn't work until/unless you've improved your aqueous layer... just my humble opinion (from my experience).

Good luck.

[kandykane1544]

Thanks spmcc. I understand that you have had rosacea for a number of years. As of now, I seem to only have symptoms in my eyes. Will I inevitably get worse? I was actually glad when I started to think I might have rosacea...but it seems to vary so much in severity. In one case somebody is prescribed oracea, combine it with some supplements and they do very well. Other people seem to struggle to find answers...what is your experience with people who have the condition? Or am I better off just not asking those type of questions ha...

[spmcc]

My thought would be if you "just" have eye problems, then stick with the ophthalmologist and follow his/her advice. The potential problem (that you should keep your *dry* eye on) is if the eye treatments kick up skin/rosacea issues. This can happen with, for example, warm compresses and MG expression.

But if skin isn't (and never becomes) your issue, I wouldn't even go there!!!! Keep your sanity - and don't do any more research/reading on rosacea!

On the other hand, if you really think you have ocular rosacea, I don't know if you'll get a "true" diagnosis without the help of a dermatologist. And self-diagnosis is not a good idea. So, maybe you want to see more/other doctors to get more info...

Conclusion: WTH do I know?!?!... I could go back and forth forever... sorry (sigh).