My first private consultation

[stella]

jlg - i ought to have mentioned that i once bought chloramphenical eye ointment at Boots-"optrex infected eyes" -It seemed to irritate my eyes and i could not figure out why - then i read the ingredients one of which was "mineral oil "and i decided that mineral oil was aggrevating my eyes
So i went to my usual pharmacist (next to the GP surgery) and asked to look at the ingredients in the Rx one my GP had ordered - It was chloramycetin 1% in soft white parrafin and liquid parrafin -- that is the one i use now, and believe it or not it is on perscription only - yet the drug content is exactly the same as in "infected eyes "- It must be cheaper or something !! - THis crazy health service we have
Hopefully you will not have the same problem as me with the mineral oil
I hope it works for you

[jlg_uk]

Hi Stella

The Optrex one is the exact same brand I got - and on the second day I'm already feeling my eyes are burning more. I'll give it a few more days probably, come off, and see if things improve. Probably the only way to figure out if the ointment is to blame.

[jlg_uk]

Hi Jlg

The strength of the steroids and how often you need to use them may depend on the level of inflammation in the eyes.

You are wise to be wary but don't be scared of them. The eye doctor should always test the pressure in your eye; possible side effects of steroids are raised ocular pressure - that is why a person should be monitored if steroids are going to be used for long periods. The goal should always be to tail off using them.

I've just collected my emergency supply from the GP; if iritis (uveitis) flares up, that is the only course of treatment open to me. I only wish it got rid of the blepharitis but it doesn't.

Good luck with it all.

Hi IE

I think that's my concern - it's been recommended I use them for 6 weeks, but without monitoring. I don't know if that's considered a significant period of time or not, and therefore whether to be concerned.

I haven't got them yet - but I do remember the ophth said to use them more frequently at the start and less towards the end.

[eva b]

jlg,
I was prescribed steroid drops early on in my saga (which didn't actually help but made my eyes more irritated, so I stopped after a few days) but to respond to your concern re monitoring... I was told a 6 week period is considered reasonable before you are "monitored" for increased pressure.

hope this reassured you, and best of luck.

[jlg_uk]

Thanks Eva - that helps. If everyone started to say "6 weeks! - that's way too long to not be monitored" that would have changed my approach somewhat

[stella]

Jlg - I felt relief as soon as i started the original ointment, which was Rx in soft white petroleum and liquid parrafin; the optrex one irritated my eyes immediately --
It would be worth speaking to a competent pharmacist and telling him my experience ,then asking how you can get the brand i use
which is made by "medicom" consultancy Ltd
235 Hunts Pond Road ;Titchfield Common ,Fareham Hants; PO14PJ England
It is in a green and white box and i have to get it on Rx only and even then i have to remind the pharmacist that this is the only brand the agrees with my eyes
Also i have been given a brand that contained" wool fats" and that did'nt agree with me either
Maybe you are not the same as me - there is very little i can put in ,on or near my eyes - especially before my tear film was intact
I am much better now and can tolreate a lot more

[jlg_uk]

An extra special thanks there Stella - helpful info as always.

Did you find the ointment irritated your eyes or your lids? For me (and I'm only on day 3), my lids seem fine but the ointment seems to find it's way into my tearfilm and cause some burning. It's the same kind of burning I get anyway so it's hard to know the exact effect here - but my eyes were OK this morning and then within 5 minutes of application I'm getting some discomfort.

I've had a sneaking suspicion that many of the drops I've used in the past my have caused their own irritation - but given that many of us only use them when we have soreness anyway - it's hard to differentiate. I think I may have to adopt a policy of using new drops wheb my eyes are fine(ish) and see if they make them worse. Of course, that has to be balanced with preventing dryness and resulting damage that may be even worse that irritation.

I'll give your recommendation some thought - do I take it the "original" ointment is the medicom brand that you need a perscription for?

[jlg_uk]

Of course, there's the wider issue that the ointment getting into my eyes isn't causing irritation directly, but rather destablising my tear film, which then causes irritation.

Maybe I should wear goggles after applying - if there's irritation then it's the ointment, if not - then it's destablising my tear film. Sensible?

[stella]

jlg - the irritation i felt was in my eyes ,not the lids - burning and hypersensitivity of the corneas
I think there are two seperate issues here ---
1 blepharitis ie inflamation of the eyelids causing the glands to be dysfunctional - that is why i use the chloramphenical ointment - to reduce the bacteria on the eyelid margins, and lubricate them
Do you feel your eyelids are dry and scratchy and itchy ? i do , and the ointment relieves that (after the heat/massage /cleansing process) I do it at night so that if it seeps into my eyes it wont bother me so much - having said that i read in bed for about half an hour after putting the ointment on and it is'nt a problem usually

2 tear film problems resulting from dryness due in part to the blepharitis (i think i also have aqueous deficiency) but the oil is not being produced to seal in the tears
That problem requires artificial tears as and when needed - a brand that suits your eyes and does not require preservatives

Goggles i found helpful only for light sensitivity and doing the computer/TV in the early days

[Seamus]

Lid tightening

H there,

I had one eye upper lid "tightening" 6 months ago, - (here in Belfast) it did no good and was a fairly horrible procedure although I did get 2 weeks off work for it. They cut out about 1/4 of my upper lid as they reckoned I had floppy skin - trouble was I had floppy skin from tugging at it due to dryness so it was always going to be a symptom rather than a cure.

To be fair "it was just a shot" - they did not promise miracles but I was/am desperate. I think I posted a query here before it but got the impression that it wasn't that common. Perhaps I am wrong - or perhaps it is even a different procedure that you are referring to. Anyway, I would not particularly recommend it - it has done neither harm nor good- although I have a few less eye lashes now.

Best wishes,

- Seamus

[jlg_uk]

Hi Seamus

Thanks for sharing your experience - I think it would be the same procedure, although with my lower lids. I'd be very sceptical anyway, as surely any significant lid shortening would be removing meibomian glands also - surely that wouldn't be good for DES?

[irish eyes]

Hi


What is meant by eyelid tightening?

Thanks

[jlg_uk]

After expressing IOP concerns about being on Steriod drops to my private ophth, he offered a quick check for free. I saw him this morning.

Notes:

- IOP is 7 in right, 9 in left
- anything under 15 is fine, but depends on person (I thought the values were higher than this),
- Only been on drops for 8 days - he said this was too soon to see adverse reaction signs anyway
- Thinking about getting checked in 4 weeks - he said if it was him he wouldn't worry
- Right lower lid had a "fence" like inflamation sign last time - not now. Unsure if this is due to treatment or refraining from scrubs
- He felt my tear film was fine - I needed to get across how variable it is really. He did see an almost immeadiate break up in my right eye one time though, and said it was a little foamy
- Lash problem was confined the left eye only, and only one inward lash. Others were just little hairs. He said my caruncles did not look irritated.
- Said things looked better even though I said it didn't feel better. He said to continue with treatment and I'd see him in Jan on the NHS

Planning to restart Doxy today.

Thought it was pretty good he gave me a short notice review free of charge. He said he thought things would improve, but perhaps not to the extent I'm looking for. He also said we were pretty much throwing everything at my problem. I'm sceptical how much I'll improve without indeitifcation of the root cause though.

[jlg_uk]

3rd visit with Mr TM

Saw Mr TM again, though this time on the NHS as opposed to privately. Notes:

- he said my eye margin looked better. I reminded him that the ridge he'd noticed the first time was likely gone as he'd asked me to stop margin scrubbing.

- he put some fluorescein (sp) in my eyes and then said my tear film was fine. I tried to explain that the fluorescein was making my eyes reflex tear, and that my eyes were feeling very wet compared to normal. I know there's definitely a MG problem.

- I explained I felt my main problem was posterior lid inflammation.

- I confirmed his earlier diagnosis of a few hairs pointing inwards and that 1 of these was bothering me, and he agreed electrolysis would be arranged (I saw the card he filled out with a diagram of my eye showing the 3 hairs). Not likely a "magic bullet" though.

- I told him about my visit to an allergist, and about the SG drops recommended. He gave me the choice between PF SG, and BAK containing Opanatol. I choose the Opanatol because he said I could always get PF SG from my GP as it's "GP level".

- I asked about plugs, and he echoed my concerns about creating a cess pool of allergens etc. He felt that now was not the right time, though he might be prepared to put them in as they can always be taken out.

- He put me on stronger steroid drops (hmm great) - Dexamethasone 0.1%. 10 X stronger in fact for a period of 6 weeks. My current IOPs are 8 and 8.

- He saw some staining on my right eye under the cornea, and affirmed that he felt I suffered from nocturnal lapth with that eye, by watching my blinking. Left seemed fine, which is strange as it's my worse eye. He wrote down SPK which
I know stands for superficial punctate keratopathy. This is the first time staining has been seen. Night time cause or maybe a result of me wearing goggles with strap too tight?

- Follow up in 8 weeks.

Didn't feel I got my tear film issue across all that well, but he did seem to think that allergens were a significant possibility. Was also prepared to ask me what medicine I wanted and accept my view on treatments etc, which is good.

[irish eyes]

Hi Jlg

Isn't the NHS brilliant? I have seen a few people in a private capacity over the years but remained `under the wing' of the NHS. My dry eyes were always dismissed as a `mere nuisance' - like many posters' experience. As I also used to suffer frequent bouts of iritis - the Eye Dept felt like my second home.

However, the dry eye condition was deemed untreatable around 3 years ago, and the Head of the Eye Dept wrote to my GP to say so - adding that my case was not that severe anyway and he had seen far worse. I had been prescribed drops and if they didn't work, it was just unfortunate. I was signed off.

In desperation recently, I asked my GP to refer me to see someone privately. I saw him last week. This chap hadn't seen many eyes as bad as mine and said it was little wonder that the pain was so severe. Private prescription for Cyclosporine will cost £480 for a months supply. When I asked the NHS Eye Dept about Cyclosporine - the idea was scoffed at. `Don't tell us our job' attitude.

My advice - keep in the `loop' of the NHS. I feel I have been left alone to cope with the problem and it has become worse as a result.