Are night time ointments safe?

[Betsy]

I was using refresh PM preservative free ointment but read somewhere it can further clog glands and maybe not allow eyes to breath. Also, petrolatum and mineral oil are considered harmful in cosmetics and creams per the EWG site, environmental working group. I trust EWG because a lot of products we use are in fact dangerous, but many don't know because it takes time for them to be damaging, like a slow working poison. So if their toxic in other parts of the body, won't they be even more so to the eyes? Yet that's what's used in ointments. Any advice appreciated. I tend to not get much responses on here and hoping to get a response at least on this. Thank you.

[MGD666]

I tried the overnight ointments for awhile, but many eye doctors advise against them (while many others recommend them!). Because there seems to be no general consensus on this, you will find different opinions. Personally, I stopped because I did not want to risk "blocking" the few functioning glands that I do have, nor want to compromise what little tear film that I have (not that it's in good shape to begin with) . For some people though, they really need the heavier ointments at night for relief, especially given that that is the time when their eyes tend to be really dry, or if they have a situation where their eyelids do not fully close when sleeping, etc...

I can't speak to your concerns though on the mineral oil or petrolatum being potentially harmful when used long term. Drops and such containing mineral oil never helped me (although are recommended by Korb, among other docs).

I now use genteal severe dry eye gel overnight (and a few times throughout the day) and then "seal" my eyes shut when sleeping with my "moisture chamber glasses w/cotton pads inside them" to keep my lids shut. Anyway, that's my $.02, for what it's worth...

[Betsy]

Thanks MGD, sounds confusing, no clear answer. I think for now i won't use my refresh nighttime one but maybe get the one you use, genteal, as I remember when I used it before the consistency was better and i think it didn't have petrolatum and mineral oil,the severe dry eye one, not the night time one.

[PeterBelgian]

Be careful with night ointment , i had a lot of new symptoms when i used it. I had an allergy to Vit-a-pos , i think its because of the lanolin but im not sure. But just try it once and if you feel new symptoms , stop it fast

[Betsy]

Thanks Peter. I already am not doing well I almost feel like I can't get worse yet of course I can but that's where I am at unfortunately so yeah, I don't want to make things worse. The opthamologist never responded to this question for me, and many others unfortunately. The thing is, during the day, I put in drops but don't see improvement at all, whereas other people have at least temporary relief. I don't know what's wrong with me, perhaps my nerves aren't working right. To think it was all manageable, not great, but manageable before Dec 10.

This is what I have now that I used just a few times:

http://www.refreshbrand.com/Products/refresh-pm (mineral oil and white petrolatum)

This one I almost got but has the same ingredients as the one above in different %'s

http://www.walmart.com/ip/Genteal-R-...3.5-G/10533275

So I'm thinking of using Genteal severe dry eyes at night, rather than their nighttime option. What do u guys think?

http://www.drugstore.com/genteal-sev...e-gel/qxp43974

Active Ingredients: Hypromellose (0.3%) (Lubricant)

Inactive Ingredients: Carbopol 980, GenAqua (Sodium Perborate), Phosphonic Acid, Water (Purified), Sodium Hydroxide, Sorbitol

[Minni]

I myself didn't do well with Refresh PM - and also not with Retaine (the latter has both mineral oil as well as Cetalkonium Chloride.) I couldn't tell whether it was the oil or chloride that was bad for me - considering the fact that Refresh-PM was also bad for me.

Therefore I'd avoid both mineral-oil, and anything stating alkonium-chloride.

Of interest:
I remember reading a post in this forum's archive where Dr. Holly advised against using gook for eyes. Of course, he didn't use the term gook - I can't remember his exact wording - but you can search his posts and perhaps find it. He may well have used the term mineral-based or petrolatum.

Actually, I'm one of those that practically nothing agrees with - that's how bad my condition is. But you guys are right - after trying zillions of stuff, the best of the lot for me are: Genteal-gel Severe (purple/red), as well as Systane-Ultra-preserv-free, and Refresh-Plus, and Similisan-DryEye. But even all these have their quirks for someone as far-gone as me, so I'm hesitant to sing their praises.

Oh, another drop that might be OK "occasionally" is Blink-Contacts. The green bottle.
The Blue-Blink proved no good for me.
Long ago, a scientist on this forum claimed the Blink-Contacts is short-chain HA and therefore not so effective. All I can say, is that short-chain is probably better for me, simply because it's "lighter", and more the consistency of "gel" rather than "oil" if you get my meaning.
In conclusion - I don't care how many scientists recommend the heavier long-chain HA. The long-chain simply winds up leaving my eyes feeling as if polyurethane dried inside them.

[Betsy]

Thank you Minni for your post. The alkonium-chloride scares me because it reminds me of the long version of BAK, as a non chemist, I don't know how closely related they are, clearly there is some relation. Minni, besides all the dry eye drops, have you tried any of the big guns as they say?

[Edan]

Hello,
I am concerned about this issue, but I have not been able to get any real medical documentation as to the long term use of gels. The few articles that I have read (gels and ointments) seem to state that these should be used with caution, but none state any specifics.

I have been diagnosed with the following:
General dry eye syndrome
MGD
RCE
I currently use GenTeal Gel (Severe) 2 – 3 times a night for the eye erosion’s.

Does anyone have any links to any research/study’s that show the effects of long term gel use?

Thank you.

[Jaybo]

Does anyone know any more about this theory of ointments preventing the eyes from breathing? I must admit that from the onset of my severe dry eyes, I noticed my eyes becoming more bloodshot after I started on the ointment. The problem is, for a few weeks before starting it, I was waking up at 4 or 5 in the morning with my eyes starting to stick to my eyeballs. And given that my eyes are still very bad (3 months later) I'm afraid to test out what would happen if I didn't put anything in at night, or even if I tried Genteal, because it didn't work for me back then. I can't tell whether my eyes would have become progressively worse and bloodshot because of the underlying dry eye, or if I'm maintaining the issue by not allowing my eyes to breathe? Like everyone else, I'm so afraid of making things worse because, as we all know, we could just create a new baseline which is hard to recover from. My eyes are horrible all the time at the moment, so I'd love to know if anyone knows if the ointment might be hindering.

[Edan]

Jaybo,

Until someone else answers, I thought I would give you more information concerning my use of ointments and gels.
I have now been using ointments/gels for over 12 years now. My eyes have gotten worse, but with my diagnosis and age (62), this could easily be considered normal.
I have probably been using GenTeal Gel for about 5 years steady now at night. The only exception is when I have an erosion and sometimes the doctors recommend Muro 128 for a short time.

Like you I would like to stop the ointment/gels, but in my case with the erosion’s and the possible damage to my eyesight that they can cause, my decision has been to stick with these until more research has been done.

I hope this gives you a little relief from worry since I have been using the ointments/gels for over 12 years with no major problem.

[Jaybo]

Thanks Edan. Do you know what sort of dry eye you have. I was told yesterday that my tear and oil production is good. I'm afraid that I have a mucin deficiency, but I'm terrified of that being the case as I'm 28 and have these issues after a course of accutane. I'm dreadfully afraid of having to put ointment in my eyes every time I sleep for the rest of my life.

[Edan]

Jaybo,

I do not know specifically what the doctors mean when they say I have “General Dry Eye Syndrome”. I have tried to pin them down what exactly this means, but they all say they don’t know. This seems to be the phrase that they all use when they don’t know the underlining problem. I have also been told by a few of my doctors that my eyes tear and oil production is 95% normal. Others have stated that the “Paper Test” (sorry, I cant remember the name for this) was the driest they have seen. My eyes are generally “OK” during the day, but dry out painfully at night.

I am also concerned about putting ointment/gel in my eyes for the rest of my life. I have been so depressed at times over this , and the erosion’s, that I have not been able to function that day. This generally happens after leaving a doctors office concerning my issues and being told I need to “just get on with my life” and try and forget my dry eyes.

What helps me is the fact that doctors are listening better and there appears to be more research into these areas. Ever so often I will “check” the internet and this forum for any new progress that has been made. And I have seen progress in the last few years, so I cling to this as an answer.

I can feel your pain at 28 years old facing this issue. Please, just hang in there and hopefully soon the doctors/researchers will have the answer.

[Jaybo]

Thanks Edan.

That is an odd one. I have no idea whether to try to not use the ointment at night because a few months back, without it, the experience was absolutely horrible, and was the case for a good two weeks before I started using the ointment. Long enough for me to feel dreadfully afraid of going through it again, or setting my eyes back in any way. Up until a few days ago I had been getting my girlfriend to put the ointment along the full length of my lower eyelid before sleeping, so that I could blink it around and then go to sleep. The advice to use copious amounts was given to me by my dermatologist. He advised that if things weren't recovering, that I should get up in the middle of the night, open my eyes to get some oxygen in for half an hour or so, and then go back to sleep. However, I've always been a terrible morning person anyway. That's even before all of this made it a billion times worse. I have done it a few times, but I'm sure you're aware that unsettling things in the middle of the night, on top of being extra tired from a mid sleep, half an hour wake, makes me feel like I don't ever want to get up, and makes me tired, depressed and uncomfortable for the whole day. He also seemed to be going off of the basis that it is what he had to do when he cut his eye with a tree branch. I can't see that the recovery would be the same in that, apart from the injury, the rest of his eye functionality should not have been effected, meaning he was in an optimum position for that healing to take place. With the medication drying out my eyes, the process of recovery is unlikely to be the same. The advice from my recent dry eye appointment however, was to use around 1cm on the tip of my finger, and to wipe that into my lower eyelid. I don't know whether it is helping yet, because my eyes are still horrible, but I can understand that the heavy ointment might restrict oxygen getting to the eyes at night, and also, for a good part of the following day whilst it remains present in the tear film.

I take it you've had all the standard blood tests done over the years? Have you had any tests for vitamin deficiencies done? Somebody informed me that (with what I'm going through) vitamin A can cause a copper deficiency. I haven't read the studies but I've been informed that copper has an influence on Hylauronic acid production in the body, which as I'm sure you're aware, is present in the eyes. I've been taking zinc lately, which depletes copper supplies (I had no idea) so I'm interested in trying a copper supplement. People can develop all sorts of deficiencies spontaneously though. I feel like I would love to be plugged into a car like diagnostic machine, to be told what's in range and what isn't, that way, if everything was fine, I would have to hope my body naturally recovers, but if it wasn't, I could address the areas that I'm lacking to give myself the best chance of recovery.

As our tear and oil production is fine, it could be the mucin element that is deficient for both of us. The one area that drops can't really help. I wonder if my goblet cells have been damaged by the dry eye I experienced and have been sloughed away. If my eyes aren't getting the oxygen they need at night, it would explain the slow recovery. It's just such a confusing place to be, because if goblet cells are hard to recover, using less ointment could cause more sloughing and damage them further, or, the ointment may be suffocating my eyes, delaying recovery. There's no way to know whether I'm doing the right thing.

[Edan]

Jaybo,

All of my blood work has been fine over the years. I have never shown any deficiency of any kind. My normal diet is basically an anti-inflammatory diet, which is basically no processed food. This has helped me and I can tell when I slip and go off the diet for a while. This took about 3 months the first time I tried this before I noticed an improvement in my dry eyes.

I do not have any choice, or at least that’s what the doctors say, concerning ointments/gels at night due to the erosion's. Over the years I have tried a few times to not use the suggested products, and I always had the erosion's again. I will probably try again in the future to stop the ointments/gels. I have talked with a few people who had similar RCE and they suddenly stopped one day. All of them stated they did not do anything different, like medications or diet, but that the erosion's just stopped for no apparent reason.

When I first started trying to get information about problems like these, a few threads in this forum stated basically that if you keep trying different things to help your situation, that eventually you will find small things that help and make life a little better and that is exactly what I have found. I hope you discover these soon.

[meibomian]

See "Meibomian" post in attached link (17-Feb-2016, 00:37) for why ointments can make DES worse. Anyone who has used ointments and continues to have DES even after stopping them or experiences worsening of DES after starting them use should consider lacrimal irrigation to clear the ducts and to check for any obstruction. Lacrimal irrigation is performed by your eye doctor in the office by inserting a blunt-tip cannula attached to a saline-filled syringe into the lacrimal punctum (tiny hole/dot at the eyelid margin near the nose) and flushing the saline through the lacrimal system/ducts. Many dry eye sufferers are surprised by how quickly their symptoms improve after lacrimal irrigation. They actually don't have dry eyes so much as an undiagnosed lacrimal obstruction. It’s generally thought (and taught) that excessive tearing is the sine qua non of lacrimal obstruction, but this is often almost never true clinically. There doesn’t even have to be a true anatomic or physical obstruction for there to be a physiologic obstruction whereby there’s impairment in tear drainage without any frank physical obstruction. An important point is that once lacrimal “obstruction” occurs, it's much more likely to recur in the future.