My guide to treatment options for Blepharitis and Meibomian Gland Dysfunction

[Kassandra]

Kassandra -

Steroids and antibiotics are prescribed for blepharitis - Alrex/Lotemax and Azasite/doxycycline, etc. Restasis is prescribed for long-term inflammation because it can be used indefinitely while steroids cannot as chronic use can lead to glaucoma, cataracts and corneal thinning. Azasite is sometimes prescribed for blepharitis. Oral doxy is prescribed for posterior bleph/mgd. Z-Pack is also sometimes used for posterior bleph/mgd. Restasis is just one option.

Gretchen

I wonder why my doc refuses to prescribe those for the blepharitis he diagnosed me with then? He wants me to take Soothe XP which I looked up and it's mineral oil.
I'm going to my primary care doc tomorrow. Maybe she'll refer me to someone who knows something about this.
My eyes were fine until this optometrist dilated my eyes during my routine exam. Now, they're flipping out.
Gonna ask her for some blood work too. :::::sigh::::::
I see way too many doctors; it can become a full time job.

[advocate]

Soothe XP has mineral oil, which supposedly does a good job replacing the oils that your Meibomian Glands are not producing. The problem with Soothe XP is that it contains preservatives which can irritate your eyes and make things worse if you're allergic to the preservative...

I wonder why my doc refuses to prescribe those for the blepharitis he diagnosed me with then? He wants me to take Soothe XP which I looked up and it's mineral oil.
I'm going to my primary care doc tomorrow. Maybe she'll refer me to someone who knows something about this.
My eyes were fine until this optometrist dilated my eyes during my routine exam. Now, they're flipping out.
Gonna ask her for some blood work too. :::::sigh::::::
I see way too many doctors; it can become a full time job.

[advocate]

You may well be right. It could be Vitamin D rather than the effect of UV light on fungii. To me, it doesn't matter why it works, as long as I get relief.

I've spent a lot more time in the sun recently and I think there's a definite correlation. My eyes look best on days that I'm out in the sun for 10-15 minutes.

By the same token, if I stay inside, but leave all the windows open and let the polluted air come in all day, my eyes get considerably worse...

If I stay inside and keep the windows closed and the air filtered, my eyes are better. When I add 10-15 minutes of sun exposure outside at some point in the day, my eyes look completely normal.

My current routine is as follows: One day, I'll walk around in circles around the pool with my eyes open and no eyeglasses for 15-20 minutes. This ensures that the whites of my eyes and the interior eyelids get good UV exposure. The next day, I'll lay out and tan with my eyes closed. The next day, I do the walking aroung thing.

Otherwise, I'm indoors for the rest of the day in my comfy, filtered, air conditioned environment.

I ran into my optomestrist the other day at Costco and she said that my eyes have never looked better....

Hmmmmm...I wonder if what you're really getting from the sunlight is Vit D as well/more than the antifungal benefits?
There's some new research out now that most Americans don't get enough Vit D in their diets or from the sun.

I like alternative positions and yours is very good. I wondered too about the hot packs for inflammation, in fact, I just went and put a cold water bottle on my eyes for a few minutes. I also wonder why Restasis is the drop of choice when there's inflammation; why not steroids and antibiotics if there's infection/bacteria present that's causing the Blepharitis?
Good help IS hard to find...

[advocate]

Kassandra,

Gretchen is probably correct.

I say probably because some steroids (Alrex) are approved for long-term use and some are regarded as safer for long-term use (FML).

The truth, however, is that nobody really knows for sure whether they are safe or not.

Some people develop high Intraocular Pressure when taking steroids (They are referred to as responders), and that's why your doctor will check your pressure when you used steroids. High IOP can cause very very serious complications, and anyone who develops high IOP should cease steroids immediately.

Even if you don't have high IOP, it is widely believed that long-term steroid use can cause cateracts. I don't know if this has actually been scientifically proven. I actually doubt that anyone had done a double-blind study on it. In reality, most people who live long enough develop cateracts anyway, and so the association with cateracts may have developed from the fact that old people tend to present with inflammatory eye conditions, take steroids, and ultimately develop cateracts. Nobody can be sure.

The point, however, is that you don't want to be the person who finds out. And so, you should avoid using steroids if at all possible.

Restatis presents its own host of side-effects. There are no long-term studies on the effect of putting Restatis directly into your eyes. For all we know, everyone who uses Restasis drops for more than 15 years could go blind (I admit that this seems unlikely). We don't know, because nobody has ever used Restasis in their eyes for 15 years.

What we do know is that Restasis' active ingredient is a very very potent immune system suppressant. I believe that it was developed in connection with organ transplants, to prevent the immune system from rejecting the transplanted organ. If it works, it is because it stops the immune system response to something that is irritating your eyes or eyelids. If that something is allergic, why not just use an antihistamine?

Kassandra -

Steroids and antibiotics are prescribed for blepharitis - Alrex/Lotemax and Azasite/doxycycline, etc. Restasis is prescribed for long-term inflammation because it can be used indefinitely while steroids cannot as chronic use can lead to glaucoma, cataracts and corneal thinning. Azasite is sometimes prescribed for blepharitis. Oral doxy is prescribed for posterior bleph/mgd. Z-Pack is also sometimes used for posterior bleph/mgd. Restasis is just one option.

Gretchen

[advocate]

A quick update: I'm continuing my 15-minute per day sun exposure with excellent results.

Today, I realized something that supports the view that UV light exposure may help people who have Blepharitis. Many eye doctors prescribe an antibiotic called Doxycycline for Blepharitis. One side effect of Doxycycline is that it shuts down your body's natural defenses to UV light. As a result, when you take Doxycycline, you must minimize your sun exposure, because exposure for any length of time will cause sunburn.

If UV exposure is helpful to people with Blepharitis, then taking Doxycycline will increase the impact of whatever small amount of UV exposure you might normally get. Thus, the better solution may not be Doxcycline, but rather to increase the amount of UV light your eyelids receive each day.

Has anyone else tried any of this stuff? If so, please post your results!

[jhollister]

Great article man. I think were in the same boat.

[LasikRelatedDES]

I'm starting to consider myself an expert to a degree on MGD/Post Bleph and I thought I would chime in.

First, sunlight. I have noticed since all of this started happening to me that I always feel better in sunlight. Whether the heat from the sun is actually warming my glands and melting the oil or if it's Vitamin D being generated, or whatever, I think we should all be making a conscious effort to be in the sunlight. Our bodies were designed for it.

However, I don't think it replaces Intense Pulsed Light. I've had one IPL treatment and admit that it was at a salon and not with a trained ophthalmologist... but man... something good happened. If you've got classic MGD and an eye doctor has ever used the term "blocked gland" or "toothpaste-like consistency", I think IPL is worth investigating. It heats your skin up to just below the burning point to get the oil moving and, from my limited understanding, may decrease the vasculature carrying inflammatory agents to the glands. But it can be pricey... so until it's covered by insurance... ha, ahem, don't hold your breath... get some sun.

I don't think doxycycline should keep you out of the sun completely unless you are very fair skinned. When I was in Africa and taking it for malaria prevention, I spent hours in the sun and I have only a light olive complexion. Between a 2 and 3 on that scale often mentioned here. But closer to a 2. 30 minutes a day should be fine even on doxy. And then you get the best of both! Docs try to scare you so you don't go sunbathing on doxy. That could be real bad.

Regarding hot compresses vs. cold compresses: I understand that cold is better for inflammation. But hot melts that oil. And more oil means less inflammation. Cold may help that inflammation but is bad for the oil. After a cold compress, my eyes stick together because the little oil I have is congealed. So, I think it's a trade off with hot compresses. Maybe if you have full blown blepharitis, use cold until you get it under control and then switch to hot to get at the glands. That's kind of what I did and it worked. I still have MGD but mostly have the inflammation of the lid itself "under control". Still not great though.

Other things that have helped me:

Restasis - 4x/day. I put a drop in each eye, blink twice, and then blink once hard to squeeze it out and over my glands.

Alrex - Got the blepharitis under control. But I don't like the BAC preservative. C'mon Bausch and Lomb. Get on the preservative-free bandwagon already. Used it for three months and now weaning off of it.

Fish Oil.

Resveratrol. (No direct evidence to support this but I know the medical community is all abuzz with its potential antioxidant miracle drug potential.)

Lid massage. When I first started massaging my lids, I could feel how inflamed and angry my glands were. I mean, they were irritated. But I kept on it and cleansed with Sterilid. And it has helped big time.

IPL. Anyone have a few thousand dollars laying around. Or know anyone in Maryland doing this well?

[lilahp]

What's Resveratrol, and what specifically does it do for you? Where does one get it?

Glad that you're doing better!

[LasikRelatedDES]

What's Resveratrol, and what specifically does it do for you? Where does one get it?

Glad that you're doing better!

http://en.wikipedia.org/wiki/Resveratrol

Resveratrol is the reason why French people eat more saturated fat than Americans but have a lower incidence of heart disease, the "French paradox". And the suspected reason is their consumption of red wine containing resveratrol.

It's basically a natural antibiotic created by plants as a defensive mechanism and is found in red grapes and Japanese knotwood. It's been shown to have anti-inflammatory, anti-cancer effects in animal studies and has been shown to increase the lifespan of yeast, worms, fruit flys, and a fish by around 50%. It did not increase the lifespan of mice but was shown to have a positive effect on their overall health.

You can buy it at health food stores and Whole Foods. I'm currently taking Jarrows Resveratrol 100 but it's not cheap. It cost me $35 for like 100 capsules or so. You can probably get it cheaper online. It's a hot item - thanks Oprah - and not a lot of companies are making a quality product yet.

I can't say I've seen a direct effect on my blepharitis and MGD from taking this, but overall I am getting better and this is just one tool in my arsenal. And it's supposed to be really good for a host of other things. Hopefully, more clinical studies in the near future will show that it has great benefits for humans and I'll already have a jump on it. We'll see...

I know some eye doctors tell people to eat red grapes for dry eye and I'm assuming that's for the resveratrol.

[advocate]

Just another quick update:

I'm continuing to get 15 minutes of direct sunlight, i.e. tanning, usually right around noon, and I'm continuing to see an improvement in a number of skin-related conditions that I have, include Seborrheic Dermatitis and Blepharitis.

I also replaced all my lightbulbs. I used to have compact fluorescent bulbs, and now I'm using regular incandescent. I'm not sure that this is going to make any difference, but I decided it was worth a try. There are some reports (particularly on Canadian or Australian government web-sites) that CFLs do release a small amount of certain types of UV light that can cause problems in sensitive people.

I know that this theory runs contrary to going out in the sun, but it is possible that the UV light from CFLs is different than the UV light from the sun. Anyway, if you have CFLs, you might give it a try (and report back!).

Finally, I've made a couple other minor changes to what I'm doing.

First, I've installed an air filter in my laundry room, and was amazed at how much dust originates there. I have to change the pre-filter every 2 weeks because it becomes clogged up. I assume that if that dust wasn't being captured, it would migrate all over the house...

Second, when I run the dryer, I make sure that I keep a window open in or near the laundry room, and keep the laundry room door closed. The dryer takes air inside the house and blows it outside. This creates a negative air pressure in the house and draws outside air in through cracks in the walls, windows, attic, etc. With what I'm doing now, the outside air only gets pulled into the laundry room through the open window, and then gets expelled back outside again almost immediately. I believe that this is helping me keep the air in the other rooms cleaner.

[advocate]

One more quick update. I continue to do well.

I have had my HVAC ducting tested and it turns out that my HVAC air ducts had a number of leaks that were sucking in attic air. My attic is filled with insulation and other pollutants, plus air from outside. I had those sealed and had my air ducts cleaned.

It turns out that air ducts often harbor dust and dust mites. Plus, some AC system components are insulated on the inside (where the air travels through), and the insulation gathers and harbors dust and dust mites. So I had those components (mostly plenums where ducts attach to your system) replaced with ones that are insulated on the outside.

Has anyone tried any of my ideas and had success? Or not?

[redandsensitive]

I must say that you're right. I have constant red eyes, dry, blabla.. But when I'm outside in the sun for like 15-30 min (or when the sun is behind the clouds), my eyes becomes bright white and feels fine. So there's something in the sun- theory!!

But STRONG lighting, wind, WINTER is RED EYES!!

Just my 2 cents worth..

[Scradley]

i can help you with Blepharitis!!

hey, ive had my Blepharitis for 6 years.. i got it in grade 3.

Advocate this thread is very good!!

- The writing in blue is my story,... you can skip past it to read what i know can help.

i first started using Golden eye ointment which was fantastic and helped me so much!! but a year later they took it off the market due to it containing mercury
(i know alot of you guys would remember that!)

Then a chemist introduced me to Lid care, but that only helped clean my eyes as it was mainly for conjunctivitis and it also took so bloody long to use.

then another doctor suggested baby shampoo to help clean my eyes, which was really helpful but unstable to use as it made my eyes extremely red.




Now i know how embarrassing and really annoying it is to walk in town or work or school with everyone looking at your sore red eyes & ask why do u have so much sleep under your eyes? and why are they red?

After all these years ive finally found a product that is extremely helpful and it makes you look like you never had Blepharitis!!

its a simple cream called DermAid. its actually for red rashes but some how its blocked my blepharitis away, ever since i started using it (a couple of weeks ago) Ive been so happy and i cant express how freaking awesome this stuff is. my eyes aren't actually red, they are actually clear white!!!!

i think its because this stuff has Hydro cortisone in it (really powerful chemical) and the best thing is that u don't need to pay loads (it was $8 at my local chemist) and you don't need a prescription for it!!!

Please people reply

[nycdryeyegirl]

Hi,

I would like to add a word of caution for those members who have Lupus and are suffering from dry eye symptoms such as (blepharitis and mgd) and would like to stay in the sunlight to help alleviate those symptoms caused by blepharitis and mgd.

A relapse to Lupus, which is a chronic systemic auto-immune disease can be triggered by exposure to direct sunlight, so it very important to use sunblock protection to help minimize a relapse to this disease, while still being able to partake of the sunlight, thus possibly alleviating some of the symptoms caused by blepharitis and mgd.

I have learned first hand the consequences of not using sunblock protection when outside, as it has triggered relapses of my lupus so I thought it might be useful to enlighten some of the members who have lupus and want to try sunlight exposure to help alleviate some of the symptoms caused by blepharitis and mgd.

Pam

[advocate]

I've updated my guide pretty significantly and so I'm re-posting it. FYI for everyone!