Better cleaning of eyelids for blepharitis - starting to feel better!

[dijon84]

I've been dealing with blepharitis since February / March this year, and I feel like I might have finally made a breakthrough! I started doing different things with my treatment 5 days ago and my eyes haven't felt this 'normal' since the bleparitis started.

What I've been doing is making sure I clean the entire eyelid area, as opposed to just around the lid margins. The thought of doing this came to me when thinking about the processes involved. Dead skin is eaten by bacteria, bacteria thrive, excess bacteria on lids cause inflammation of lids, inflammation of lids causes problems with the MG glands, dry eyes result. Another thing I thought about is an observation my GP made a few months ago about me having deep set eyes (so much so that you can't really see my upper eyelids when my eyes are open). Then I found out that when I close my eyes normally, there are still folds in the upper eyelid skin. To stretch out the eyelid skin completely, I have to close my eyes then either raise the muscles around my eyebrows (quite difficult), or stretch the skin out using my hands (basically pushing up on the skin around the eyebrows). Anyway, the point of this is that the folds of my eyelids are probably an ideal place for bacteria, as they get so little exposure to the outside.

My previous routine that I've been doing for the past few months:
- Have a shower in the morning. Wash my hair every day, cycling through different anti-dandruff shampoos each day (Head and Shoulders, Nizoral, Selsun). I also use the shampoo on my eyebrows. After a few minutes, I let the foam from the shampoo run over my closed eyes.
- After the shower, a warm compress over my eyes for 5 minutes.
- Clean the eyelid margins using Blephasol lotion on the end of cotton buds (using a few cotton buds)
- Just before bed, I do another warm compress then more lid margin cleaning.

Changes I made 5 days ago:
- When letting the shampoo foam run over my closed eyes, I make sure that the skin of my upper eyelids is completely stretched out (using one of the two techniques above)
- When using the Blephasol lotion, I now clean the entire eyelid area - from below the lower lid margins, either side of the eyes, up to around my eyebrows. I make sure I clean around the folds of my upper eyelids in particular. I make sure that I'm as gentle as possible with the cleaning.

I know I'm not completely better yet but I feel like I might be on the way there now (there was an improvement on the first day that I added these changes to my routine). Just inside my eyelid margins, there is still alot of redness and the bases of my upper eyelashes are white (it's been like that for months, despite my best efforts at cleaning).

For info, I have been taking flaxseed oil twice a day for several months now. I try to eat healthily and get plenty of sleep. I have been taking eye health supplements (Visionace) for a few months, but I'm starting to think that this might be the wrong tack - it's changes to my skin health that have made me feel better the past 5 days. Anything else to improve my skin health might make me feel even better (such as dietary changes). I have ordered castor oil from the internet as it helps some people with blepharitis - I haven't plucked up the courage to use it yet.

The only other change I've made recently is drinking one or two cups of green tea a day (I've been doing this for a few weeks now). Don't know if this has also helped.

Hope this is useful to someone
Dave

[littlemermaid]

it's changes to my skin health that have made me feel better the past 5 days

Dave, thank you so much for telling us your regime improvements. So very kind and helpful and very encouraging, needed that. Interesting: just wondering if you might be overdoing the stronger antifungal shampoos, even if you think you are seb bleph aetiology? For info, we are Head & Shoulders maybe 3/week, it definitely clears the sebaceous signs, and interestingly hair, skin, eyes get worse if we don't use it. So glad to hear you're comfortable. You haven't got collarettes at the base of your eyelashes, have you? Has anyone said?

[dijon84]

Possibly I might be overdoing the antifungals. Probably once a week for Nizoral and Selsun, then H&S for the other 5 days might be better for me.

What you say about getting worse if you don't use shampoo: the day before I did my new routine, I was away and didn't have the chance to do my compresses or have a hot shower (nor the previous evening). My eyes were feeling very gritty that day.

About the bases of my upper eyelashes, I'd say there's very little debris on them but the bases just look white. It's been like this for months, whatever I've tried to clean them. The bases of my lower eyelashes look fine now, but it is easier to clean them. I've often wondered if it is debris or depigmentation of the upper lashes. Any suggestions for what to do? I've looked for similar images on the web - I'd say some of the lashes on the left of this picture look similar to mine
http://t2.gstatic.com/images?q=tbn:A...gNt9uv5urA-7PJ

Thanks
Dave

[spmcc]

Possibly I might be overdoing the antifungals. Probably once a week for Nizoral and Selsun, then H&S for the other 5 days might be better for me.

Dermatologists have told me and other family members to

1) get all 5 active ingredients - cycle one each day - DO NOT skip days - wash EVERY day. This cycling of shampoos/treatments is done to avoid developing resistance to the active ingredients.

2) do not use other shampoos (related to #5)

3) to kick start treatment, wash TWICE a day for a week to 10 days

4) scrub (yes, scrub) the scalp, behind and in ears, eyebrows - let suds sit on face - let stand for 2 minutes

5) Avoid perfumes/scents - because some shampoos (e.g., H&S) have perfumes, get an Rx from your derm for a compounded shampoo that is zero-perfume/no scent

6) you can also get an Rx for higher concentrations of the active ingredients

Good luck.
Sheila

[littlemermaid]

Dermatologists have told me and other family members to

spmcc, Very, very interesting and useful - is this for seb derm condition or specific fungal? We are shampooing like Dave every day but rotating with tea tree components, and occasional mild products - she is rosacea hypersensitive so I am worried about chemicals but with a lot of rinsing and gentle eye attention it's generally fine, just some flush.

[spmcc]

spmcc, Very, very interesting and useful - is this for seb derm condition or specific fungal?

The directions above are specific to seborrheic dermatitis which often goes hand-in-hand with rosacea. (see link for some stats: http://www.rosacea.org/patients/seborrhea.php)

Also, because of rosacea/seb derm/freakishly-sensitive skin (all of which I have), precautions about perfumes/scents should be taken seriously. The benefits of using the "proper" treatment shampoos can be erased due to perfumes/scents. So, if you're following all orders and not seeing results, it could very well be because of perfumes/scents in your medicated shampoo.

FYI One basic way to tell if there's still a problem is if there is itching of the scalp.

[littlemermaid]

Thanks, spmcc. For info on aetiology in case it helps anyone, LM's MGD started at puberty with sebaceous imbalances. She was colonised slightly by Tinea Versicolor (Malassezia furfur) after camp, v common with sebaceous types, which cleared with Clotrimazole (unfortunately 1% hydrocortisone in UK, steroid-free in the US, I think). I think hydrocortisone triggered periorificial rosacea sensitivity which now infects (search: child steroid induced rosacea). Tinea versicolor actually would have cleared easily with tea tree shampoo and a scrub, it's superficial.

With this seb derm aetiology, I saw clear meibom for the first time after starting antidandruff shampoos. I did not see clear meibom before, even after 1.5y antibac ointments and oral antibiotics. I like Pyrithione Zinc in H&S working on the sebaceous glands.

We improved diet from animal and emulsified fats (solid at room temperature) to healthy oils + supplementing occasionally with fish/flaxseed oil capsules. Also essential. Now we are maintaining clear meibom, concentrating on restoring eye surface and tearing.

We also control sebaceous flareups and resulting infection with antibacs and topical antibiotics, and that's working too but it's not fixed. Maybe we are too cautious. During those times we stop oral fish/flaxseed oil. Entirely related to, ahem, testosterone.

We're having great healing results on rosacea dryness and redness with OTC medical honey + beeswax cream. I'm trying to persuade her to try MediHoney Wound Gel (trialling NHS for antibiotic resistant bugs).

Still searching for the ultimate mineral sunblock - any suggestions spmcc?

Again, this is a specific aetiology for sebum probs and MGD and rosacea sensitive skin. It's not going to help with aqueous deficiency but it's worth a try for obstructed MGD, especially if there might be as yet unidentified dermatophytes involved. But that's another theory.

I need to add, that when we tried the topical retinoid Adapalene, I saw a similar change response in the MGs to what was happening to seb glands on chin - golden exudation - and yes, we used it nowhere near the eyes. What we use on our faces and scalps affects our eyes - as spmcc says we need to cut out the chemicals where there is sensitivity.

No derm or ophth has ever agreed with any of this! Thanks again, Dave and spmcc. Hope it's going well for you. Dave, I remember someone else replied on the white lash base but can't remember who. You were saying dairy-free made you feel better too? I think I would check the MGs before deciding how much oil to supplement with because it sounds like, similar, overproduction if you have oiliness around the eyes and nosefolds. To clarify, we do shampoo every day.

[dijon84]

I'm having two teaspoons of flaxseed oil in the morning, and again with my evening meal. Do you think that might be too much then? I've had greasiness around my eyelids since at least the start of my problems - I've looked at older photos of me and the greasiness might have been there before the start of the problems.
I know I've seen a post about whiteness at the base of the eyelashes (I remember with very good quality photographs). I've tried searching the forum for it many times but can't find it. I remember it was in the past two months or so. Can anyone help locate this post please?

[littlemermaid]

Hm. Maybe. If you are pumping out sebum already. We lay off the fish oil a bit when it makes her too oily but she def still benefits from some. Has to also be good diet for good quality meibom. Main thing is to assess your own meibom (bathroom mirror, good light, 2 fingers under lower lash line, gentle press upwards, look for line of tiny dots). I tried by clicking on yr name to get forum posts list but got to go...

[spmcc]

Thanks, spmcc. For info on aetiology in case it helps anyone, LM's MGD started at puberty with sebaceous imbalances.

I don't know the cause (etiology) of seb derm, rosacea, etc. except to say that they're all "genetic short straws".

I'm curious about your use of the term 'sebaceous imbalances'. Do you mean oily skin? Does that necessarily mean LM has seborrheic dermatitis? I don't know.

She was colonised slightly by Tinea Versicolor (Malassezia furfur)

I don't know what this is, but it doesn't sound good.

We also control sebaceous flareups and resulting infection with antibacs and topical antibiotics, and that's working too but it's not fixed. Maybe we are too cautious. During those times we stop oral fish/flaxseed oil. Entirely related to, ahem, testosterone.

Has LM has her hormone levels tested? Oily skin could be related to hormone imbalances.

We're having great healing results on rosacea dryness and redness with OTC medical honey + beeswax cream.

Due to my rosacea, I am ultra-cautious about topicals and tend to not use ANY. Every doctor I see (for e.g., at IPL places) says he/she has the best topical that I must buy. I don't fall for it anymore.

I stick with metrocream which is the main topical for rosacea. Come near me with anything else and your hand will be swatted!

Still searching for the ultimate mineral sunblock - any suggestions spmcc?

This is the catch - sun is a trigger for rosacea. But sun helps improve seb derm.

In addition, rosacea skin is known to react to SPF. That is why I don't use any daytime creams because they usually contain an SPF. Nightime creams are best (if you're going to use any).

So, in general, I avoid any SPF (including mineral makeup) and use hats when I need to protect from the sun. On the other hand, I also try to get a little sunshine on my face to help improve my seb derm.

I remember someone else replied on the white lash base but can't remember who. You were saying dairy-free made you feel better too? I think I would check the MGs before deciding how much oil to supplement with because it sounds like, similar, overproduction if you have oiliness around the eyes and nosefolds. To clarify, we do shampoo every day.

This is how it was described to me... Think of the flakes you can sometimes see on the hairlines of people, in their eyebrows, and even (as an ophthalmologist will say) at the base of the eyelashes. If it's seb derm, then all of these flakes need to be removed. That is why when I was instructed to shampoo with medicated shampoos, I was also instructed to use my fingernails to dislodge all flakes/debris on my scalp, eyebrows, etc.

So basically, it's not enough just to put the shampoo on the scalp and swish it around, you need to scrub/scrape/scratch the areas too. Of course, I'm not saying you're supposed to hurt yourself or draw blood, but you are supposed to loosen and get rid of any flakes.

Here's an NIH website with more info which explains what I was trying to say: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001959/

All the best,
Sheila

[littlemermaid]

Sheila, I'm so grateful for this, esp the time you took to think about it for us and benefit of your derm experience. We are in a similar place ongoing, working to improvement. Basically, she wants to look normal and I'm hoping to find regime/products/makeup to effect that for her without flaring up more rosacea.

By sebaceous imbalances: cradle cap ongoing through early childhood, cleared with T/Gel shampoo, maintained easily on tea tree shampoo. However, on the stroke of puberty she started with obstructed MGD, flaking between eyebrows exactly as you describe + pre-rosacea signs inc hypersensitivity, periorifical acne, permanent red nose. Now has flushing. Never had normal acne elsewhere eg forehead, back.

Tinea: fungal infection around eyes is underdiagnosed, microbiology difficult. Presents sometimes just as recalcitrant MGD and eyelash loss, unless there are visible surface or sub-epithelial signs, reaction, growth, eg to culture you need to suspect a specific dermatophyte. This is why I think an OTC antifungal shampoo is a good thing to try just in case for this aetiology. Skin fungi are naturally occurring, but they love sebum. MGs are sebaceous glands, lash follicles pump out oils too. Eg tinea versicolor (Malassezia furfur) is very common, shows as hypopigmented patches or not at all. Example of colonisation of sebaceous skin type (pubmed: tinea, eye) which can cause MGD and eyelash loss. This is another reason to like antidandruff shampoos for sebaceous derm.

Metrocream: I'm gonna try something stronger like this now she's older, we get nowhere on erythromycin. I'm worried about setting up SJ with chronic use of topical antibiotics, she seems to have atopic reactions to oral antibiotics.

Eye flareups for LM, infected MGD or only red eye, are premenstrual or during virus, like normal colds. Beautiful skin clearup in sun 2wks ago, but red nose worsened, also dryness, despite hat. This is entirely consistent with what you describe. So happy and reassured to talk to you. Will read link again. Warmest wishes for your good comfort.

[spmcc]

I will send you a PM with more of my thoughts regarding seb derm, fungal/yeast infections, rosacea and treatment.