MGD/my visit to Dr. Latkany

[Kathel]

Hello all,

I saw Dr. Latkany this past week and wanted to pass on his advice to me as it may pertain to many of you. He says I have MGD due to ocular rosacea, which is also complicated by my allergies. I had plateau'd on my therapy (doxy, warm compresses, omega 3's) and it appears to be because I had not adequately addressed my allergies (in fact, was not diagnosed until one month ago), and I was being too timid with my eyelid hygiene/gland expression. He showed me how to pull sideways at the corner of the eye, then use a Q-tip just under the eyelid margin and roll it towards the eye. He used enough pressure to press in on the eyeball, which I had not been doing. Then, you have to pull down the lid a little and wipe the margin with a Q-tip. He recommends doing this once daily, after showering. In fact, he recommended that the only heat I was to use was the shower itself; otherwise, use cool compresses, as the glands are inflamed. He says that I should never had gotten plugs, as they aren't helping (I don't have aqueous deficiency) and might be hurting. He recommended careful attention to allergen avoidance in the home and workplace, as much as possible. OK to try oral and nasal allergy meds. I'm trying to put all these recommendations to work. He reassured me that I should do well. Hope this helps me and maybe some of you.

Kathel

[GeorgeT]

Hi Kathel,

This was a great experience!!
I have MGD/ocular rosacea, and I realized in last two weeks that MG's expression is most important. Unfortunately I was doing it little more aggressive and I got one plug halfway out.
Did Dr. Latkany recommended how to do expression if you have plugs ? Any precautions?
Have you had Schirmer test? TBUT?
Could you explain "the enough pressure to press in on the eyeball" ? It was this a little hurting?

All best !

George

Hello all,

I saw Dr. Latkany this past week and wanted to pass on his advice to me as it may pertain to many of you. He says I have MGD due to ocular rosacea, which is also complicated by my allergies. I had plateau'd on my therapy (doxy, warm compresses, omega 3's) and it appears to be because I had not adequately addressed my allergies (in fact, was not diagnosed until one month ago), and I was being too timid with my eyelid hygiene/gland expression. He showed me how to pull sideways at the corner of the eye, then use a Q-tip just under the eyelid margin and roll it towards the eye. He used enough pressure to press in on the eyeball, which I had not been doing. Then, you have to pull down the lid a little and wipe the margin with a Q-tip. He recommends doing this once daily, after showering. In fact, he recommended that the only heat I was to use was the shower itself; otherwise, use cool compresses, as the glands are inflamed. He says that I should never had gotten plugs, as they aren't helping (I don't have aqueous deficiency) and might be hurting. He recommended careful attention to allergen avoidance in the home and workplace, as much as possible. OK to try oral and nasal allergy meds. I'm trying to put all these recommendations to work. He reassured me that I should do well. Hope this helps me and maybe some of you.

Kathel

[Kathel]

Hi George,

No, he didn't mention any particular precautions about doing gland expression with plugs. There was no pain with the pressure, but there was enough pressure to move the eyeball sidways a little, if you can picture it. He says it's no harder than most people rub their eyes anyway.

I have had Schirmers' tests in the past (ranging from 7 mm to saturated) and TBUT of 3 one year ago, but Dr. Latkany didn't do any of those. In fact, he knew just by talking with me for a few minutes what I had without even looking at my eyes. Of course, he did look at my eyes, which confirmed his diagnosis. When he pressed on the glands, I felt a bunch of oil being released, which really felt good. The best thing was when he told me that I would get through this and feel much better with the right regimen. Good luck,

Kathel

[brudni]

Thank you for your info on heat

Hi,

I have ocular rosacea complicated by severe allergies and other things too and was using heat and found on my own the heat was aggravating my problem.

Thanks for writing the information you learned from your doctor's visit. I am very confused myself when I should use hot and cold compresses as I know cold can aggravate rosacea also. Did Dr. Latkany tell you when to use the cold presses and is there any regimen for them?

How cold is cold? I do find the cool eye drops quite soothing. Have you found much relief from the Doxy? What has been the most help to you?

My eyes are worse in the morning as the lids are always swollen but after cleansing, massaging, and my present medications they are much better. Do you have a lot of swelling in the morning?

I keep my bedroom as allergen free as possible, cleanse and lubricate at night, but it seems the tears just do not flow properly without gravity's effect. And even with a hepa filter you can't live in a bubble.

Please let me know more about cold compresses and what helps you.

Thanks,

brudni

[Kathel]

Hi Brudni,

I'm glad I was able to post something helpful. Dr. Latkany didn't say how cool the compresses should be, but I've found on my own, like you, that they shouldn't be too cold. I try to do two or three compresses per day, as time allows. I have been on the Doxy for over one year, and I think it has helped, because when I try to decrease my dose, I seem to get worse. But the biggest thing to help me has been my Pataday allergy drops. Dr. Latkany gave me permission to use them twice daily instead of once, and it's made a big difference in just one week. Allergic reactions release a lot of toxic mediators that kill your goblet cells. So, addressing allergies is very important. I'm now able to read at night, for the first time in 2 years! Good luck,

Kathel

[stella]

Hi Kathel
Are pataday allergy drops preservative free?
I suspect my MGD is compounded by allergy issues
I have found oral doxy really helped but fear i may be getting used to it as it is not working quite as well now (i have been on it for four months)
You say you have been on it for over a year
Have you ever tried doxy eye drops ?
That is my next goal - But since i am from the UK it is not easy to get
I dont know if i have rosacea - i could well have -again it is very hard to get properly diagnosed over here
Cheers
Stella

[robinzb]

sorry, whats Q-tip?

[Rebecca Petris]

sorry, whats Q-tip?

Cotton bud

[brudni]

Thank you for your response

Thanks for your response. I have wondered why they have not put me on an antihistamine drop like yours. I am a Stevens Johnsons survivor so no one wants to give me doxy but I will ask about the Pataday. It may be a great supplement or for my Clarinex. I am afraid to be without the Clarinex.

Presently I am tapering off steroid drops and restasis. I do have SLK which is inflammation but have tested negative for thyroid but I suspect it is just another weird allergy reaction as last year it was hives not eye problems, before it was sinus infections. It seems like my allergies are taking a new form every year!

I will experiment with the cold compresses.

Again thanks for your info as the rosacea is tricky. Like you I don't have white stuff but you can see the oil.

brudni

Hi Brudni,

I'm glad I was able to post something helpful. Dr. Latkany didn't say how cool the compresses should be, but I've found on my own, like you, that they shouldn't be too cold. I try to do two or three compresses per day, as time allows. I have been on the Doxy for over one year, and I think it has helped, because when I try to decrease my dose, I seem to get worse. But the biggest thing to help me has been my Pataday allergy drops. Dr. Latkany gave me permission to use them twice daily instead of once, and it's made a big difference in just one week. Allergic reactions release a lot of toxic mediators that kill your goblet cells. So, addressing allergies is very important. I'm now able to read at night, for the first time in 2 years! Good luck,

Kathel

[Kathel]

Hi all,

Thanks for your responses. Stella: the Pataday drops do contain BAK preservative, unfortunately. It doesn't seem to be bothering me, as far as I can tell. I have not tried doxy drops but may do so. FYI: I tried Metrogel (metronidazole) on my lower eyelids today,as I read an article about it. My eyes have been burning all day, so maybe it wasn't such a good idea. Oh, well, every experiment is an adventure!

Brudni: I would certainly ask your eye doc about Pataday or similar drops. As far as the Stevens Johnson syndrome, what drug caused it? Doxy very rarely causes any allergic reactions.

Kathel

[TARYN]

Kathel, is Pataday better than Patanol?

Kathel,
You seem to like Pataday. Have you tried Patanol? Do you feel Pataday is better than Patanol?

[brudni]

It was sulfa for a problem which doctors couldn't figure out and it was many years ago. I was extremely lucky with the eye treatment I received and that I survived the ordeal. The ironic thing is I didn't need an antibiotic. The same thing happened with my dry eye. The first opthamologist put me on Vigamox for my episcleritis as he did not know what I had. Never needed an antibiotic according to other physicians. So far I am doing much better thank goodness, but like almost everyone, it has been a challenge to find the right solution. I am luckier than most as it has only been months instead of years dealing with severe dry eye. Are your allergies and eyes better in the winter? My problem started in the fall, went away in the winter and returned in the spring. This coincides with allergy season here, hence I suspect my allergy connection, along with heat induced rosacea flare-ups and I noticed it has just spread to my eyes this year. The question I don't know is which is causing the majority of my eye problems, allergies or rosacea.

Because of my history even though doxy doesn't have a history of reactions, my latest opthamologist said they are really afraid of putting anyone with Stevens-Johnsons on long term antibiotics. But in October I am trying a new dermatologist my new opthamologist recommended and I will speak to my allergist who really literally saved my life, my eyes, and my skin! The challenge will come when I am completely off of steroid eye drops.

I also really love the Eucerin Redness Relief cleansing gel which has really helped my eyes as I use it for my daily cleansings. I called Eucerin and it is safe to put directly on the eyelids.

Brudni

Thanks for your responses. Stella: the Pataday drops do contain BAK preservative, unfortunately. It doesn't seem to be bothering me, as far as I can tell. I have not tried doxy drops but may do so. FYI: I tried Metrogel (metronidazole) on my lower eyelids today,as I read an article about it. My eyes have been burning all day, so maybe it wasn't such a good idea. Oh, well, every experiment is an adventure!

Brudni: I would certainly ask your eye doc about Pataday or similar drops. As far as the Stevens Johnson syndrome, what drug caused it? Doxy very rarely causes any allergic reactions.

Kathel

[Kathel]

Taryn,

Patanol and Pataday have the same active ingredient; Pataday is designed for once daily usage and that's the only difference I know of. I have only tried Pataday and Elistat. There are some others that are supposed to be good as well (Optivar, others).

Brudni,

I can't blame you for not wanting to go on long term antibiotics with your history. Can you take aspirin? One aspirin daily can help with rosacea flushing and is an anti-inflammatory. As far as seasonality goes, I think I get worse in the summer, when molds and grasses are high, and in the winter when we have cedar season. But since I just found out what I'm allergic to, I'll now be better able to correlate my symptoms with what's in the air. Today, I was outside a lot and my eyes were burning pretty bad. After coming in and doing a cool compress, I felt better. It makes me wonder if the molds, which are very high right now, are acting as a trigger. It really takes detective work to sort all this out!

Kathel

[TRiBaL]

I was wondering, how do you know your eye problem is allergy related. If your eyelids are having a itchy sensation? I am allergic to many things but I think my allergies are under control, I don't seem to sneeze or itch much until spring.

[NYer]

Tribal, that's a good question. I had no idea that I had allergy issues with my eyes until I saw Dr. Latkany earlier this week and he told me that I do. I'm going to go to an allergist next week and find out what I'm allergic to (I suspect it's dust and mold). But it's not like I have itching and burning or anything obvious. I thought I just had rosacea.