Big improvement from omega-3 but still afraid

[andreas2]

Hi everyone (sorry for the long post),

I have blocked oil glands leading to dry eyes. It started shortly after I got seborrheic dermatitis so they have to be connected. One doctor I went to explained it as the seb derm causes inflammation on my eyelids and the swelling causes the oil glands to get a little blocked. His biggest recommendation was heat/massage.

I can see white stuff (seb derm flakes (see quote below) or blocked oil glands?) on my eyelid margins, much more on my lower than my upper. However, if I use a q-tip I can remove some of them. The first eye doc I went to (when I didn't know that blepharitis coul cause dry eyes) said to use a q-tip or cotton pad to clean the eyelid margins once every day and that would be all I needed. On the paper she gave me it said to use warm compresses before cleaning the margins though. When I drag a q-tip on my eyelid margins it gets a slightly yellow color. I'm guessing that's oil?

So I don't know if I have normal mgd or whatever. I don't have any veins on my eyelid margins. Their color look very healthy for the most part (they might be a little redder when I wake up).

I think it is important for docs to learn to differentiate between different "mgd's" (the eyedocs I went to just called it blepharitis). I found this on the internet:

In meibomian gland dysfunction, examination reveals dilated, inspissated gland orifices that exude a waxy, thick, yellowish secretion with pressure. In seborrheic blepharitis, greasy, easily removable scales develop on eyelid margins. Most patients with seborrheic blepharitis and meibomian gland dysfunction have symptoms of keratoconjunctivitis sicca such as foreign body sensation, grittiness, eye strain and fatigue, and blurring with prolonged visual effort.

Most patients with meibomian gland dysfunction or seborrheic blepharitis have increased tear evaporation and secondary keratoconjunctivitis sicca.

But another site will say that seborrheic blepharitis does not cause dry eye (it's just anterior), another say that it's the same thing as mgd, etc.

What if all it took for someone with seb derm blocked oil glands is to use whatever they use to control the seb derm on their scalp/eyebrows (Nizoral, H&S, sensun blue, etc.) on their eyelids. Create hostile territory for the fungus there --> less inflammation --> less flaking. The late Dr. Gilbard recommends dandruff shampoo for seb bleph in one of his articles.

Anyway, I have had big improvements since starting taking omega-3 (TheraTears Nutrition). It started on day 27 and gradually gets better evey day right now (on day 39 now). Besides that I wash with sterilid. Those are the only things I'm doing right now (I'm gonna add things very slowly and not start a million things at the same time). Day 27 of omega-3 was day 1 of sterilid so I know it's the omega-3.

However, I'm a little afraid that the omega-3 might help me in some ways but in the background the "mgd" worsens. For example, what if the omega-3 is increasing my already-normal tear production so I think I'm improving but the real cause of my dry eyes gets worse in the background.

Anyone think I'm afraid by nothing and should just be glad for my progress or could there be something behind my fear?

The heat therapy also confuses me. I've read some studies on it and if they're correct the way 95% of eye docs teach out shouldn't work. The eye doc I went to said to use a cotton pad soaked in hot water, hold it against my eyes, and then massage after (no reheating or anything). There's no way cotton pads retain heat long enough to make a difference (according to the studies) but he's supposed to be one of the best dry eye docs in the area so his patients have to get relief somehow since this is such a normal problem.

[andreas2]

I just found an article by a doctor from India:

http://www.homoeopathyclinic.com/art...lepharitis.pdf

Meibomian gland inflammation (seborrheic meibom-itis)
may be superimposed on seborrheic blepharitis. The patient
complains of burning of the eyes in excess of the findings,
especially just after waking up (chronic conjunctivitis
meibomiana). Photophobia occurs when the cornea is
involved. The lids are swollen and thickened, the
meibomian glands are inspissated, and large quantities of
oil (often having a purulent character) can be expressed
from the meibomian gland orifices.

Meibomian froth, which arises from agitation of the oily
secretion by blinking, is present on the lid margins (See Fig 3).

The first part I put on bold is almost exactly how the latest eye doc I went to explained it. So maybe the omega-3 helps so much through its anti-inflammatory/anti-swelling property.

I have noticed meibomian froth on the upper inner corner of my right eye (sometimes on the upper outer corner of my left as well). It looks like small water bubbles on the eye. I always wondered what it was.

[y-gwair]

Hi, glad to hear your eyes have made some progress.

You raise quite a lot of questions, it's a bit complicated but will have a go at answering some of them.

I'm told I have some seb. derm. secondary to rosacea, in that the inflammation in my glands/eyelid capilliaries seems to result in too little oil; it sounds like you may have the opposite problem. It's all very confusing. The trouble is that with all of these skin/eye conditions (rosacea/seb derm/other types of dermatitis overlap to some degree), not all the symptoms show/flare at the same time, so it can be difficult to get a firm diagnosis or a consensus of opinion from the various dermatologist/ophthalmologists, and some of the advice can seem contradictory. I've had so many conflicting diagnoses of both eye and skin problems over the last year, but I saw a dermatologist recently who helped me understand how all these symptoms/conditions interconnect.

The problem with MGD is that there are some quite complex interactions going on, which means you need to combine several different regimes simultaneously to keep them under control.

I think the most important is to keep the glands open and clear. If the glands become blocked, the oil can back up and actually cause the whole gland to become mis-shapen; over time, the gland will lose the ability to keep an even flow of oil, and finally atrophy completely. If the oil has become viscous in nature, its more likely to block the gland opening; heat will help melt the thick oil and thus unblock the gland. Scrubbing with Q-tips or clean mascara brushes helps loosen plugged gland openings. Massage will help flush any stagnant oil from the whole length of the gland to help keep it in shape and functional. All of these techniques combine to help keep the gland clean and in good condition.

One reason why the MG oil becomes viscous may be to do with the quality of the oil (lipids) your glands produce. This is why omega three oil supplements are thought to be helpful, as they help to balance the 'wrong' sort of fat we tend to consume in a Western diet. These are thought to have pro-inflammatory qualities, and be more inclined to solidify at body temperature; they may also prone to being broken down further into inflammatory substances by bacteria, setting up a negative feedback loop of inflammation/oilyness.

Sterilid has quite a lot of detergents in its ingredients (according to the derm I saw this week), which may help break down and remove build up of the wrong sort of oil, thus help prevent bacteria proliferating. I found Sterilid much more effective than using water/cotton bud, so I would think what made the difference was the addition of detergents. I wouldn't be tempted to use preparations meant solely for skin near your eyes; eye tissue is much more delicate and easily irritated than skin.

Re. eye compresses I agree, I think a cotton pad wouldn't hold heat for very long. Current ophth. recommends 'eye bag' which retains heat for about 10 minutes. I have found it helped in the rare instances when I've had obviously blocked, slightly swollen and infected glands. However, my experience is that heat is very bad for ocular rosacea where glands are not blocked but merely underproducing due to inflamed capilliaries, caused by abnormal reaction to heat in the first place. I don't think ophths. really understand this difference, applying heat is the very worst thing for making inflammation worse in true rosacea.

I really wouldn't worry about the omega three making things worse in the background. It sounds like your problems are mainly to do with MGD (oils breaking down into irritant substances, causing poor tear film/evaporation), so keeping up all the combined hygiene routines/massage/dietary supplements rigorously will help over time. I suffer from severe aqueous deficiency (secondary to thyroid/connective tissue disease, which has damaged my lacrimal glands) in addition to MGD but even so, now that my MG function has improved, my eyes feel pretty much normal even with low tear volume. It's fairly rare to have problems with lacrimal glands if you don't have either autoimmune disease or lasik-related dry eye, so try not to worry about that.

[andreas2]

Thanks for your response. Glad to hear that your eyes are getting through now as well.

It's definitely confusing. There seems to be different "versions" of MGD and I think eye docs should focus more on "subclassing" instead of calling everything one word.

My omega-3 improvement really is huge. My eyelid margins even feel cooler throughout the day than before (before they would feel warm sometimes in the evening but now they're really cool all day). I don't need artificial tears, I see 95% clearly all day (my left is a little worse than my right), my eyelids/eyes never feel tired/strained anymore, I work in front of a computer 8-9 hrs a day without a problem. I still need to blink "harder" or close my eyes for a few seconds sometimes though to get rid of some blurriness.

I have seen some people with ocular rosacea writing that omega-3 was the only thing they needed to keep their dry eyes in check so maybe it could be all it takes.

My biggest problem before was that my eyes were too watery. They would get dry/irritated one day (always redness from the inner corner of my eyes to the middle) and then for the next 5-6 days my eyes would be faucets, tears automatically sliding down my cheeks several times a day. That hasn't happened in two weeks now and it seems to be getting better everyday.

Nizoral works so good on my scalp that I'm really curious to see what would happen if I used it on my eyelids (the eyedoc I went to said that the same thing happens on my eyelids as on my scalp, inflammation->flaking/dandruff), but as you say it could be way too harsh for the thin eye skin.

Hopefully in six months or so I'll make a thread in the triumph section. I'm not gonna change my current omega-3/sterilid regimen until I've taken the omega-3 for at least 90 days though.

[y-gwair]

Yes, give each new thing time to work before changing or adding anything new. Keep a diary, noting changes.

I think the problem with sub-classing is that ophthalmologists aren't dermatologists, so may not identify the exact skin problem that may underlie the eye problem; dermatologists may have differing opinions as well. Rosacea really isn't that well understood as a condition at all, there are numerous subtypes with different degrees of vascular / bacterial involvement that respond to different drugs.

Goodluck and best wishes for continued progress.

[andreas2]

Thanks!

Well, I have had continued improvement and am feeling close to 100% (left eye drags it down a little) most days. I still don't think I can wear lenses for several hours without any help though (have only used dailies, which I hear are horrible for dry eyes, before though. want to try proclear 1 day).

Will continue to update but for anyone with seb derm mgd dry eyes, the only things I do (right now) are:

• Take TheraTears Nutrition when I wake up (day 27 was when I felt they started to make a (big) difference)
• Use a q-tip with water to just remove debris/flaking from my eyelashes/eyelids in the morning
• Wash with sterilid after exercise in the evening
• Use q-tip as before just before I go to bed (this time I "scrub" (gently) a few times on my lid margins (eyes open) as well, same as 3rd step in Dr. Latkany's book).

Of course I also try to control the seb derm on the rest of my face.

[andreas2]

I have continued with the above routine and my eyes are even better than last month.

Most of the time I don't think about dry eyes anymore. Seb derm on the rest of my face and anterior blepharitis occupy my mind more now actually.

With that said I still don't think I could wear contact lenses as before.

I'm now quite sure that it's the anti inflammatory effect of the omega-3 that helps me. I had a cold last week and the two days that my cold was the worst my eyelids felt really strained, like the veins of my eyelids would pop or something, and those two days my eyes were really watery (tears would continuously flow out automatically), similar to before August this year. After those two days and the end of my cold my eyes have returned to goodness again so it seems like the inflammation/swelling of the eyelids really is the main culprit (as my second eye doc said).

Anyway, I'm gonna finish my third bottle of omega 3 TTN and then I'm gonna try and add either Blephasteam or TearsAgain spray. I wanna give Tearsagain a try because you can use it with lenses. It seems like one of those products that doesn't have much reaction from customers online but I found a "private" Swedish forum where opticians ask each other questions and give each other tips and they were very positive about it. Apparently their patients have had great results and it usually takes around 4 weeks. If it can remove eyelid inflammations as those studies on it suggest then I'm on board. I've also always wondered why there are tear substitutes but not oil substitutes, since a lot of dry eye patients have some problem with the oil layer. Also, spray > drops.