My 2nd visit to an NHS Ophthalmologist

[jlg_uk]

Thanks Ian.

And just to clarify for the avoidance of doubt, no offence caused - as I say, I appreciate you were trying to fix a problem for the benefit of everyone (like a good moderator should). I just had to jump in quick before those Google bots hit the unprotected links!

The off topic issues we got on to might be helpful reference for others who may decide to share photos. And indeed this thread is pretty done anyway as I saw an optomitrist today and I intend to post a new thread tomorrow when I get some free time about that which is the next step in my story. Of course if people have major worries about what we were saying then I certainly wouldn't try to stand in the way etc - but we were pretty civil compared to pretty much all of the rest of the Internet so I think we're fine leaving it

Oh and by the way - a pre-emptive congrats on your 500th post

[Rebecca Petris]

We'll post something in the technical help section about photo sharing. No one will find it here once it drops off the recent post list.

[Plat]

Please see link on seborrhic Blepharitis. It is caused by increased mebium and thus causes unstable tear film and clogged glands. Think of oily skin, and when there is excess oil on the skin it cloges your pores.

http://www.aoa.org/documents/QRG-10A.pdf

[jlg_uk]

Thanks Plat - it is true I've always had a reasonably oily face, and dry scalp.

To be honest seeing that list, I'm not sure which one I have - think I might need to ring the Drs and ask for clarification!

[jlg_uk]

I was going to make a separate thread about this, but time has passed and the memory has diminished somewhat.

The day after the NHS visit, I saw my optometrist. I asked him why the NHS ophthalmologist had said I was producing too much oil, where he had said my glands were blocked. He said it wasn't contradictory, but rather just that the quality of the meibum was poor. He expressed some glands and took a photo (which I'm trying to get from him) showing my pupil will a light source relfected - and you can see lots of other dots in the tear film.

He called this "lipid bergs", and indicated this was chucks of solid lipid (and hence more emphasis on warm compresses I guess). He also everted my lids and didn't see the inflammation I feel I see when I take a photo of my lids (well, as much as I can do it anyway which is no where near what he could do). I'm not sure if this is good or not really - I feel happier when I have an explanation for my DES problems etc.

He wants to refer me to a private ophthalmologist - I think I will make a separate post about my worries on this though (assuming I don't get lazy again).

[Smithy K]

Hiya

Just wanted to say that my GP wouldnt even consider referring me to a Opthalmologist. I guess I would have to keep going back to her, or pay privately. I like you, wanted answers and reasons. She just said the same old same old...Viscotears! Maybe if she had DES should would rethink this. (she did utter something about her eyes becoming dry with her contacts in, but she can just take them out cant she !) I do seem to be feeling a lot better over the past few weeks. Preying that it is going to miracuously disappear over night some time !!!! (I wish)

All the best
Karen

[jlg_uk]

Hi Karen

Looks like we live in the same county

I went to Kettering Hospital last week, and it was actually the 2nd time I've been referred, but I've been in the system a while. Fingers crossed all goes well for you, but if not, it might be worth seeing your GP again and making it clear how this affects you.

[jlg_uk]

Sorry for the delay in replying Eva - got caught up with other things

I also wonder about seeing a dermatologist - after all the problem is in the SKIN, albeit the skin is on the eyelid, so there has to be some connection don't you think? I've never heard of seborrheic blepharitis either, but my optometrist said I had a "rough patch" on the inside of my upper eyelid...I
wonder if it's the same thing?

I still need to get what he actually said confirmed (after seeing all those variations in the link plat helpfully posted), but I don't think a rough patch on the posterior lid would be the same thing. That would sound like a conjunctiva problem to me (not that I really know).

I have heard of people making too much meibomian fluid and still getting dry eye symptoms - can't remember who, but someone on this forum I think suffers from this problem.

I am reasonably convinced that there is a problem with my meibum and/or glands after my optomitrist squeezed them and shows me crap in my tear film, but I'm not really sure why this is - nutrition, dermatological problem etc? Is it the meibum or the glands themselves?

Doesn't this all stink?

100% agree! Easy to get down about it sometimes to be honest. Pretty QoL (quality of life) destroying.

Are you going to go ahead with the treatment this specialist has prescribed for you?

I guess I have to - such as the treatment is. 4 times daily compresses (well I was already doing daily) and drops. Appreciate that's the front line treatment but hasn't done anything for me so far. Plus, didn't even seem to care about other possible contributory factors like aqueous deficiency etc. Ah well.

[Smithy K]

It sure is a small world jlg !

I have an appointment at Kettering with my thyroid specialist in December (Dr O Malley) and am going to have a nice chat with him about it too !!!! (He may even refer me, as Thyroid can affect the eyes (Graves) too! you never know !!!! may get me a foot in the door!.

Although like I said, I have had a few very good few weeks ( scared to actually say that incase I get a re-bound). My last horrible inflamation/flare up was 1 week after being diagnosed by Specsavers (my eyes were sore, itchy and red raw), I went to Majorca - yes, the 30C HOT DRY Heat is a no no.NEVER AGAIN! They constantly stung, and were quite red. But here we are, heading towards winter here and they feel lots better - I just keep on slapping on the Viscotears 3 times a day, - seems to do the trick. The only thing that really irratates is the air con in my office at work - when we have the heat on - it is terrible. But I am going to fight not to have it on - would rather be cold !!! (Or wear lots of layers!)

Although alcohol is still an issue too, it is slowly getting more tolerable. At one stage after one stumpy bottle of french lager - they went blood shot !!!! Bizare!!! I can now drink at least 2/3 pints before they start going red !! :O) heee - So binge drinking is a NO NO for me too - not such a bad thing I suppose!!!!!! (Just get fed up with people moaning that I'm not drinking like they are!!!)

Take Care - I am rambling!
Karen

[jlg_uk]

It sure is Karen

Sometime ago I saw someone was posting from Rushden or similar (unless that was you?)

Good luck with getting referred - though hopefully you're getting better like you say. Viscotears a few times a day won't do it for me - but I've got some new Wiley X goggles and am trying them out in the office today with some good results.

Alcohol affects a lot of DES suffers I think - but while I don't usually drink in the week, weekends are a somewhat different matter

[Smithy K]

Hiya
Nope, I dont live in Rushden, but just over the River Nene, in I'boro!

[jlg_uk]

I'boro!

Ah k - I know it. I remember once helping a friend deliver a big heavy sofa up the steps on the highstreet with the railings. I had to lift one end up over my head and needed a couple of goes at doing it! (I'm not a delivery person).

I live in that place to your west, W'boro! Yep - small world alright

[jlg_uk]

For reference, I've been told today that the written record of the appointment I had diagnoses me with "bilateral meibomian seborrhoea".

No mention of posterior blepharitis although that was mentioned in the appointment (perhaps that is implicit though).

That means too much meibum. Hmm, though I recognise that too much meibum makes the tear film unstable, I'm not sure that's my problem. Sometimes, using a 12X mirror, I can see I can express oil out of my glands, other times I don't think I can. When I do express them, my margins look pretty dry (I can sometimes see tiny spots of meibum from my upper lids deposited on the lower - I wouldn't see this if they were always awash with oil).

I don't have confidence in this diagnosis.

[irish eyes]

Hi

Why don't you have confidence in the diagnosis? Was any treatment / therapy suggested?

[jlg_uk]

HI IE

I don't have confidence because it doesn't seem to match what I can see with my own eyes. I'm not completely confident enough to proclaim it's wrong though.

Treatment consists of lid hygine/hot compress 4 times daily (I'd been doing once daily for previous 3 months) and PolyVinylAlcohol drops 4 times per day. Next appointment 3-4 months (this was after I'd said it was job threatening).