General Advice needed for very desparate patient

[lollipop]

Hi

OK I was diagnosed with Blepharitis last Monday by my hospital after referral from Doctor.

I am only 80% sure I have this and not something else as I do not have any crusting etc associated with Bleph.

My symptoms: extreme dryness, pink or red eyes, which are a little worse at night, inability to now wear lenses, when I close my eyes it feels like they are frantically trying to gather moisture. Drops/Gel only give mild relief and wears off quickly.

I was given a sheet of paper which told me to daily clean eyelids etc with baby shampoo. Up to now Im not sure if this helping.

Along with any advice you may be able to give, I would like to ask 2 questions.....

I bought a humidifier. Should I have this on day or night or both? Ive read on here that eyes can be more dry at night??? why is this?

Also I want to but a sleep mask. Do I use the mask and humidifier together at night?

Thank you
Lorraine

[Rojzen]

welcome; lots of potential directions

Lollipop, I will include reference to your question about fluoxetine here, along with replies to your other questions.

Yes, SSRIs like fluoxetine can trigger or exacerbate dry eye symptoms, but this kind of side effect is individualized, and should not be assumed or anticipated in all cases. I make this point primarily ALSO to say that depression and anxiety, particularly when severe, are both ALSO potential triggers of dry eye symptoms. That fact can be an important consideration when evaluating whether to discontinue an SSRI medication.

You question your blepharitis diagnosis, and that shows you are well on the way to being your own best advocate and healer, by challenging and looking for deeper answers! Dry eye is a syndrome with a wide range of potential causes and factors. Most of us here have multifactorial cases, such that our meibomian glands (effectuating posterior blepharitis) are not working well, at the same time as our lacrimal glands (and adrenal glands, for that matter), are not working so well, either. But one CAN have posterior blepharitis, for sure, without there being crusts and deposits on the eyelid margins.

Your doctors can check for meibomian gland dysfunction by expressing the glands gently and seeing what happens, but generally, if your tear film is unstable, while you are producing an adequate supply of lacrimal tears, then it is probable that meibomians are involved by not providing enough or good enough lipid secretions. In addition, the mucin layer of your tear film may not be optimally functioning, because certain layers of your conjunctivae may be stressed, and not generating enough of the cells that support mucin production and function.

Some of us here, moreover, have recurrent corneal erosions (some severe, some milder). . .This can alter tear film stability, too.

I would not fret now about contact lens wear, because generally, only therapeutically designed contacts are going to improve a dry eye condition, making it easiest to improve without wearing conventional lenses.

There is no one best way to use humidifiers, but we have an immense body of information here in archived posts and Encyclopedia entries about proper use of Tranquileyes, which are sold in the Shop here.

I would propose you add a few dimensions to your care, if possible. In addition to improving your environment, and using a moisture goggle at night, you can give your tear films time to catch up by wearing protective eyewear even indoors. Wraparound glasses can serve this purpose, as can customized or commercial moisture chambers (available now as MEGs, described fully in many posts here).

For direct treatment of your tear film instability, there is an over-the-counter product available in the UK called Clinitas Ultra 3. It functions quite uniquely, and is not based on the principle driving other products, which is simply to pour viscous fluid on to your stressed eye surfaces. Matheson's and many other companies carry Clinitas Ultra 3. To learn how it works, read about the work of Dr. Frank Holly, in the department here dedicated to his science. His products have been found by many here to help greatly with lacrimal deficiency, meibomian gland dysfunction (MGD), and corneal erosions. Improvement on these products can take time and patience.

Looking forward to reading the excellent advice you'll be receiving here from many other members. We're with you every step of the way. . .

[dianat]

I feel almost infantile following up on an informative post such as the one Rojzen just delivered, but I wanted to add a couple of things. Well done, R.

I personally find myself obviously more comfortable in a humid environment than a drier one. Humidity any time, day or night will work to your benefit. Some who have offices keep a small humidifier in their offices or cubes.

We have one on our furnace that releases a small amount into the air. We keep it low because my son has bad allergies and keeping it higher really isn't healthy for any of us. I do, however, keep a large humidifier in my master bedroom and take advantage of the additional high humidity at night. Some may not realize how much humidifying helps, but if you've ever spent the night in a hot, dry hotel room you'll notice.

I do also wear an eye mask to help keep my eyelids shut. This is crucial for me as I believe my eyes do not blink or close properly. I can say that even with the mask on, I find I feel better with higher humidity. On a similar note, when I first developed dry eye and wore goggles to sleep, we were still keeping our ceiling fan on at night. That fan, despite the fact that my eyes were shut and covered, was a real problem. It hasn't been in motion since.

One last thing with regard to your lid cleansing...

If you are using baby shampoo, do know that you must dilute it a lot. You might check the encyclopedia here for information on a suggested ratio of shampoo to water. There are theories that the shampoo isn't a good idea at all. Plain saline might be a good alternative, as well as some products that are specifically made for eyes that can be found at any pharmacy.

Perhaps someone else out there can speak more specifically to this treatment. I do not do scrubs, but did try them long ago. I've read a lot over the years about how people handle them.

My best to you.

Diana

[lollipop]

Bleph and Humidifiers

Wow Rojzen and Diana, thanks so much for all that information.


At the moment I do feel like I have been to a certain extent fobbed off by my hospital and Doctor. Everytime I visited him he had to refer to a book and I ended up getting through a variety of 6 bottles of eye drops, anbiotics, tears, allergy drops etc. And when I eventually got a referral to the hospital, I went to the emergency eye department where I was for about 5 minutes, my eyes were briefly examined and I was given a sheet of paper out of the draw which explained Blepharitis.

That is why basically I feel that maybe the diagnoses may not be correct!

I will talk with my Doctor next week aobut stopping the Fluoxetine to see if it helps. I was just trying to work out when the dry eye started and it co-incides with the same time I started the Fluoxetine.

The Clinitas Ultra 3 sounds interesting. I will DEFINITELY ask about this in my pharmacy Monday. I cannot at the moment find a UK supplier of the sleep goggles. I cant believe it. Ive found one who say they "might" sell them in a month or two but its so surprising. Indeed if you have heard of a UK supplier, please please let me know :-)

On the sheet I got from the hospital It says to use Baby Shampoo. I use one teaspoon in half a pint of water. It doesnt make them sting but I cant see much improvement either at the moment.

I feel bad going back to the Doctor to say its still bothering me as they do look at me like "well what more do you expect me to do" kinda looks.

I thought of trying one of those chinese medicine places. Has anybody ever tried one?

[irish eyes]

Hi Lollipop

I tried Chinese herbs but they didn't help. I visited one of those Chinese Herbalists that you find on the high street - so it could be that there was quite a lot lost in translation! Also, one doesn't know how pure the product is - so I wouldn't go down that route. Go somewhere reputable; check the Register of Chinese Herbal Medicine www.rchm.co.uk. This was set up to regulate the practice of Chinese herbal medicine (CHM) in the UK. Represents the fully qualified practitioners of Chinese herbal medicine. They can direct you to your nearest RCHM member for help and advice. (There are other sites also)

I do know exactly what you mean when you say you felt `fobbed off'. I could write a book on it. I agree with Diana on the point about baby shampoo. It made my eyes very sore - but the hospitals still tell patients to use it. Having said that, I am trying Burts Bees baby products at the moment and they don't aggravate at all. (I think Sodium lauryl sulfate was the culprit in the other brands) A bit pricey - I bought a `starter kit' at a local shop. The shopkeeper didn't think it at all strange when I said it was for me - and not a baby. I'm finding the soap is better for my skin than some of the special cleansers that I have been using - and paying a lot of money for! Good luck.

[lollipop]

Hi thanks for that.

Is there anything else I can use that is cheap to clean with? It also says a teaspoon of bicarbonate of soda on my hospital form, maybe i should try that?

Also the cleaning routine. I ask myself the question am I doing it right?

I put a warm compress on eyes, probably not for long enough as I have to keep eye on baby :-) I clean the actual eyelid, the root of the lashes outter and inner and do same with lower lashes.


Is this about right?

[irish eyes]

Take a look at the images here:

http://www.agingeye.net/otheragingeye/blepharitis.php

Bicarbonate of Soda is often used - so you should be OK with that.

It's hard having to do this if you have a baby as well. On the days that I need to leave early for work, I try to get a `burst' of warmth on my eyes when I am in the shower. I have to be careful with this because it can end up being very drying.

I sometimes use a `wheatbag' to warm the eyelids. I got mine from the `EyeBag Company'. You can see how it works in principle:

http://www.eyebag.co.uk/

You will no doubt have read about the importance of diet and drinking plenty of water.