Inflammation caused by Blepharitis

[Francesco]

Dear Dr. Bazan,

I'm 23 and after 6,7 years of redness, burning, grittyness in my eyes, i discovered i had blepharitis. Conjunctival staining was also 3/4 so almost severe (this i think explains the gritty feeling).

After healing the conjunctival epithelium using systane 4 times a day and working on MGD with compresses and massages (my glands are fine now) the next point was the chronic redness (mild to moderate).

My doctor prescribed Lotemax for:

2x daily for 15 days
1x daily for another 15 days

well after this i saw almost no improvement of the redness(just a bit during the first 2 weeks).

Now, was the dosage too low??? Once redness develops is there something it can be done to reduce it??? Are steroids able to reduce it only temporarily??

Thanks a lot for your help!

[Justin]

After healing the conjunctival epithelium using systane 4 times a day and working on MGD with compresses and massages (my glands are fine now) the next point was the chronic redness (mild to moderate).

Thanks for presenting your case. I'm sure a lot of people reading this are in a similar position. Congratulations is in order for your dedication to proper lid care. It is great to hear that you have a handle on the MGD and the ocular surface is healing. Don't forget that you are only controlling the bleph with the lid care...you slack off, things will get worse again. Be diligent, it will be come so routine you won't even think about it.

Chronic redness is a concern to me, and without a formal exam and history, it is really inappropriate to speculate. However, I would say that you have brought up some excellent issues to discuss with your eye doc at your follow up.

My experience has been that Lotemax needs to be dosed about four times a day to get moderate inflammation to subside. You are also correct, and lotemax is often considered only a short term therapy. Longer term therapies to control the inflammatory response include restasis, omega-3 nuetraceuticals, and oral drugs like doxycycline.

Also, if the redness was related to a condition that has been resolved, and your blood vessels have not acquired permanent damage, there should be a point where they will naturally return to a normal appearance. Ask your doctor more about what the expected course of your condition is and what the full therapy plan includes.

If your chronic redness has flare ups, keep tract of them. See if you can piece together all the things that are associated with the flare up. What are the triggers?

[Francesco]

Dr. Bazan,

thanks very much for your detailed answer...! You really look like a very competent and passionate doctor Excuse me if i ask you some other questisons..

- How long do i have to wait before i can re-start using Lotemax again 4 times a day (this time) and maybe adding Restasis after 2 weeks???

- Is it dangerous to use it a second time even though for a short period???

- My blood vessels are still there but the blepharitis is under control..what do you mean with permanent damage? is there something one can do if they are damaged?

Thanks and sorry for these questions but not all Doctors are so helpfull and sensitive

[Justin]

Dr. Bazan, thanks very much for your detailed answer...! You really look like a very competent and passionate doctor Excuse me if i ask you some other questisons..

No problem, your welcome. Thank you for helping others by asking great questions.

- How long do i have to wait before i can re-start using Lotemax again 4 times a day (this time) and maybe adding Restasis after 2 weeks???

Ask your doctor. I commonly Rx both Lotemax and Restasis concurrently.

- Is it dangerous to use it a second time even though for a short period???

Research Lotemax. It is probably the safest steroid we use. http://www.eyeupdate.com/pages/corti...teprednol.html

- My blood vessels are still there but the blepharitis is under control..what do you mean with permanent damage? is there something one can do if they are damaged?

The constant constriction and dilations the visine causes, might have permanently damaged the vessel walls. If that is the case, the possibility exists that they will always appear a little distended. Sorry, but I do not know of a treatment for that. I really don't even know how to prove that is the case. I would not give up on treatment by any means. Keep in mind that it was years of abuse, so it will take Time for things to get better. Schedule a follow up with your doctor. I think you are armed with some helpful insight.

[lboogie]

Hi Dr. Bazan,
I'd like to follow up on this thread with a question about redness and swollen of the lids. I have dry eye and oil gland inflammation because of lasik (4 months ago). I have been doing all the usual stuff -- warm compresses........oral doxy, and restasis.

But my eyes still look tired and inflamed. The whites of my eyes look totally normal, I do not have crusty/flaky stuff --but the very edges of my lids are redish/ purplish and generall inflamed looking. Especially in the evenings, but not all all when I wake up. They also look inflamed after being outside for too long. Are there other things to try? Could I have allergies on top of everything?

AND of even more importance to me right now is dark circles..........in your professional opinion can inflammed tears/ eyes be draining into my sinus area and causing the really, really dark pools of purple in my eyes? I'm so self-concious about it all. I'd apprecite any advice you have.

[yoganut]

Dr Bazan:

Sorry to hijack the thread but not sure how to post messages to you otherwise. I'm 41, had DES diagnosed for about 1 year. For 2 years before my eyelid margins would get extremely itchy at night and sorry to say would be scratching away at them. An opth gave me Fougera FML (?) ointment to apply at night and it went away. Last year I wore my contacts (only wore very occasionally up to then) all day every day while on vacation and 2 weeks later developed what I thought was an eye infection, looked like pinkeye plus painful and lots of stringy mucous. Since then I've been on lotemax on and off and Restasis for about 6 weeks but then went off it.

Since then tried various tx as suggested on this board, rice baggy (left my eyelids dry and inflamed) fish oil (broke me out in huge cysts) and lid hygiene (occusoft and sterilid). Switched opths and my new one has put me on Restasis and lotemax x4 per day, so far its been 3 days and no relief, I really thought the lotemax would start working on the inflmmation, perhaps the Restasis is counteracting it though? I did ask him in my exam if I have occular rosacea or clogged meibomian and he said no to both, - what good would doing warm compresses and lid hygiene do in my case? The only good thing about being on Lotemax the past 3 days is my eyelids no longer itch like they did and my eyeball isn't stuck to my eyelid when I wake up like it used to. Sorry for such a long post, this new opth of mine is ok, he claims to have dry eyes but even so I do not feel like he is very interested in my condition.
many thanks.