Prednisone (those w/dry eye not caused by Lasik)

[PotatoCakes]

Has anyone tried oral Prednisone? In any dose?

My mom's eye doctor does a fair amount with dry eye patients and he was surprised no one had mentioned a trial of Prednisone.

I'm not a huge fan of Prednisone because the side effects are so bad but it might be worth it if it really helped me. This doctor said it can also be used to (generally) rule out auto-immune issues if a patient doesn't see improvement. It makes sense because Prednisone does help with various auto-immune issues but I was wondering if anyone else had heard of it used for dry eyes or had experience with it.

Thanks!

[Spoon]

Hi, I use prednisolone eye drops on rare occasions (Prednisone is the pro drug of prednisolone). I bought a box of 20 minims and have used one about every two months on average, which last for around 3 days. I find it very effective at removing inflammation. I would never use a systemic for ocular surface inflammation as the topical drops are so effective but i suppose if its to tame or test for a systemic autoimmune issue then that is different. I doubt if it would help long term as it is only suppressing the inflammation and is not directed at the cause of it. Good luck if do try it!

[y-gwair]

I would be careful using prednisone. I have autoimmune issues but I had a bad reaction to taking prednisone tablets recently for a bad flare of facial swelling/oedema, and I'm not sure it's always the case that you can rule out autoimmune issues if you don't respond either. The few days I was taking it, I'm not sure I noticed any improvement with my eye pain either, and there was a definite rebound inflammation on the face burning/swelling when I stopped (you should always taper them, regardless what doctors tell you, mine said it didn't matter). It's possible to have different conditions co-existing, if rosacea is part of the problem then this could easily be made worse by steroids too.

[PotatoCakes]

I took Prednisone as a kid for allergies (eyes swelled shut, etc. Moving & newer drugs have since helped) and don't remember any bad reactions from it although I know people get bad reactions and our bodies change with age, plus, I was on a really low dose (just enough to stop my eyes from swelling shut but no more because the side effects are so bad) & I'm not sure what kind of dose my mom's doctor recommends. This doctor said you had to be on it at least a week to see results.

Y-gwair - I'm surprised your doctor said you didn't have to taper. That's horrible. That's something I'd consider switching doctors for because that's really basic knowledge (for an M.D.), in my opinion. Were you on a very low dose that maybe he thought it was low enough not to taper? Still, it's not good. When I was a teen, I thought my dosage was so small I didn't need to taper and ended up with a massive lecture from my dad, whose specialty wouldn't necessarily involve Prednisone.

Good point re: reducing inflammation. If the cause of my glands not producing is NOT inflammation, that would make sense that Prednisone wouldn't work.

[y-gwair]

20mg, not huge dose. I only agreed to take it to make a point (GPs insisting it was angioedema/allergic reaction when it clearly wasn't).The swelling turned out to be photosensitivity, and seems to be responding to increased dose of hydroxycholoquine (plaquenil), which is why I'm not convinced that all autoimmune issues invariably respond to prednisone. Even some forms of atopic dermatitis (which can affect the eyes/MGs) can be refractory to steroids, and are sometimes treated with systemic ciclosporin as a last resort. If you think you have an underlying AI condition, it's better to try to get it diagnosed accurately and seek a more targeted DMARD than prednisone, though this can be a painfully long process.

[PotatoCakes]

One of my eye doctors is convinced I have Sjogren's despite my negative tests and complete lack of other symptoms (no dry mouth, no other AIs although once an MD said I had a super mild case of Rosacea that another, more experienced MD later told me I do not have -- just that I have typical fair skin).

I've been tested for more things than I can count and an AI is the only thing that seems likely at this point. This is really my only health problem and no one seems to know what to do with me. I am awaiting results from a hormone test (progesterone and testosterone) but wouldn't there be other symptoms if that was the problem, particularly since I'm only 40? My thyroid is fine, although I do have a speedy metabolism. Not lacking in any nutrients that I'm aware of (tested for D and since I live in the NW do take a supplement but my levels are fine) and I eat an incredibly healthy diet although one naturopath did tell me I probably don't get enough fat in my diet so I take 4 fish oil & 4 flaxseed oil supplements every day. I'm currently taking compounded Restasis (mineral oil free) and it hasn't worked yet. Prior to that I took the regular kind and it didn't work. Back in 1996, I took regular Restasis and it did work but that was a long time ago. I'm not producing any kind of tears whatsoever. Something's got to be causing this and I just can't figure out what, besides an AI.

[spmcc]

I know you're asking about oral steroids, and you probably already know about topical (eye drops) steroids, but I thought I'd mention that I recently saw an oculoplastic ophthalmologist and she asked me if I had ever had steroids injected into the lacrimal glands.

She asked me after she did a Schirmer's (all four of my puncta are sealed, but I was still 2 in each eye). She said that I was severely aqueous deficient.

Anyway, she said something about lacrimal glands perhaps being inflamed and how the injected steroids act directly on the glands to reduce inflammation and allow the glands to produce tears. I think it's basically a "shot in the dark".

This would seem to me to be a step "up" from steroid eye drops but not as "extreme" as oral steroids. Just a thought... but maybe someone who's had this done could comment.

[NeedMyEyes]

There are doctors that perform superior tarsal (inside the eyelid) injections of triamcinolone (steroid) for Giant papillary conjunctivitis. It works really well for those eyes. It seems to me it could work for MG inflammation in the upper eyelid also - no?

Regarding the systemic prednisone - just so you know, the side effects of steroids are much greater if you use them systemically than if you just use eyedrops. Cataracts are much more likely with systemic steroids than with topical steroids.

Also, it doesn't seem like systemic steroids would be nearly as effective as local steroids, like an eye drop.

Regarding doses (and only your doctor should tell you what dose you should take), but just to give you an idea - for daily Lupus, some get Prednisone 5 mg once a day for control. For COPD exacerbations, some give Prednisone 60 mg once a day for 2 weeks, 40 mg once a day for 2 weeks, then 20 mg for a week, then 10 for a week, then stop. Just to give you an idea.

[y-gwair]

One of my eye doctors is convinced I have Sjogren's despite my negative tests and complete lack of other symptoms ... Something's got to be causing this and I just can't figure out what, besides an AI.

It's very difficult to get firm diagnoses for problems at the edges of immune-mediated diseases. Where dry eye/mouth present without any bloodwork, the condition is referred to as Sicca syndrome, and dryness symptoms can actually equally or even more severe than those suffered by true Sjogren's. Often it occurs in people who have family members with other AI problems, which suggests an underlying immunological cause, but without any bloodwork for the usual inflammatory markers it's unlikely you'll get a referral to rheumatology. I've found hydroxychloroquine (Plaquenil) has helped with a lot of my rheumatological symptoms (I finally got a diagnosis of UCTD last year, basically the mildest form of systemic lupus) but it hasn't helped with the dry eye-related issues. Topical steroids may have helped a bit, currently waiting to try ciclosporin drops. Remember, dry eye is considered an inflammatory condition even in the absence of any known systemic AI disease, although the mechanisms don't appear to be that well understood as yet.

I've never heard of injecting steroids directly into the lacrimal gland. I know that aggressive treatment with systemic immunosuppressive drugs like methotrexate or ciclosporin can suppress active inflammation in the lacrimal gland and improve tear volumes in trials, so it might be worth trying if your ophth. really thinks it might help.

Apparently topical steroids almost cleared my papilliary conjunctivitis last time, but it now feels like it's back with a vengeance. I was going to ask about injections of triamcinolone re. my swollen, oedemic lids, but that seems to be remitting with the skin photosensitivity; I might pursue it if the ciclosporin doesn't improve the lid pain.

[PotatoCakes]

I was referred to a rheumatologist about a year or so ago and she tested me for Sjogren's and a few other things. All of my tests were negative although she did precribe Evoxac, suggesting it might help my eyes a bit. I took it for 3 days and stopped because it made me sweat and salivate so profusely it wasn't something I could continue. I actually came close to choking on my own saliva a couple of times at night it was so bad. Since this is my only symptom, she didn't think there was any reason to continue seeing me unless something else cropped up. My eye specialists monitor my eyes and there wasn't really much for her to do unless I developed other symptoms (which I haven't).

No one in my family has any auto-immune disorders.

I mentioned the Evoxac to my new primary and he said that it wouldn't help my eyes because the tear glands are very different from salivary glands in the way they operate, etc. We discussed a number of things, including LDN, so I don't remember everything he said, especially since I didn't plan to go back on it.

[Mawsky]

Im very interested in the autoimmune aspect of this dry eye thing, I do have some autoimmune issues, I have alopecia Areata, allergies and eczema, I just recently stopped using the restasis, my eyes seemed to get better, and when I used it it irritated my eyes so bad. I most recently started using the preservative free thera tears, and I've been really saturating my eyes with the drops, this is the longest I've gone being pretty good, still don't have any tears to cry, but right now more comfortable. I really feel that hormones are playing a big role for me, I too tested neg for sjogrens, do you have any other issues?

[PotatoCakes]

Mawsky - I don't have any other health issues (ok, bad knees but not bad enough for surgery and I've worn glasses since I was in 8th grade). That's what is so frustrating about this situation to me. I feel like I'm just out there with this really bad problem without any reason. A diagnosis would help me in some ways, even without a cure. Have you tried compounded Restasis / cyclosporin? I get mine through http://www.leiterrx.com/ -- I don't know if anyone else makes it but apparently Leiter's is well known in medical circles for things like this. My doctor called in a prescription and they mail it to me. The mineral oil / castor oil (can't remember which) was causing an allergic reaction for me. When I stopped using regular Restasis and the night ointments with oil in them, the redness and inflammation in my lids went down a LOT. I was also experiencing a lot of burning after using regular Restasis. With the compounded Restasis, I feel a tiny bit of tightness and then it's normal but no stinging. My eye does get a little red after administration but nothing like the regular Restasis. I haven't been on it long enough to know if it will work for me but the regular stuff wasn't working and it was definitely causing problems so at least now I don't feel like I'm doing damage. You might talk to your doctor about getting compounded Restasis and see if it works better for you.

[y-gwair]

Sicca syndrome can be related to hormone levels, not solely an immune issue. Oral/ocular sicca aren't solely associated with Sjogren's (which is a pretty rare condition), they are pretty common symptom with most AI diseases, particularly thyroiditis. Sometimes inflammation is undifferentiated, which means none of the usual markers will show up, but immunoglobulins (IgA, IgG, IgM) will be raised (sometimes with positive/weakly elevated ANAs).

Re. evoxac/pilocarpine, it's best to quarter the tablets and take more frequently rather than take whole ones, this will significantly reduce the unpleasant side effects. Ophths. seem divided on whether they help eyes, mine thinks they do. The research is also divided on the degree to which they help/alter ocular secretions. The effects on glands aren't necessarily instant, they tend to build up gradually over a couple of months.

[PotatoCakes]

y-gwair - That's good to know about the evoxac. I think mine are capsules -- if I were to try it again, how much of the powder would you suggest taking at once? 1/2 a capsule or less?

I just got my hormone test results back and apparently (disappointingly) they are normal. As were my thyroid (TFTs?), CVS, RS, GI, CBC, no sarcoidosis, SSA/SSB & IgG normal, ANA negative. I was tested for Osteoporosis and came up pre-osteopenia but I'm very small boned and that shouldn't affect my eyes. Allergy tests showed me allergic to a few foods but elimination for 10+ weeks showed no difference. I'm allergic to every pollen out there, grass especially, but not mold or dust, interestingly. I do have large pinguecula/pterygia (they have not grown over my cornea but do have blood vessels in them so I'm not sure what to call them) on the outer sides of both corneas but they easily could have developed due to the dryness.

[y-gwair]

That's a pain re. evoxac capsules. I've only taken pilocarpine (=Salagen, evoxac isn't available in the UK), which come as tablets, I'm not sure it would be easy to divide the powder in a capsule. I wish I could take it, it did really help with dry mouth but it caused terrible burning sensation in my mouth, plus my tongue started to swell up, I dare not try it again.

I know what you mean about tests, it's always nice when you finally know there is a reason for something. But good news that you don't have an AI condition, I know dry eye pain is terrible in itself, but I wouldn't wish the dry mouth, joint/muscle pain, burning rashes etc that also come with these conditions on anyone.

It's awful when you've tried all the options and none of them help, I'm rapidly approaching this point too (only ciclosporin ointment left to try, and I'm not very hopeful as so few people seem to be able to tolerate it). It's just so unfair, isn't it?