Viscotears (SDU) and infections

[tony walker]

Dry Eye together with a diagnosis of MGD had generally been kept under control using lid scrubs ( Johnsons Baby Shampoo ) and using Celluvisc .05 % drops. Then in Sept 2011 I suffered an upsurge in pain and was unable to do much , watch TV use PC or read for a few minutes with sore and pink eyes. Visit to consultant prescribed Cyclosporin and then a change to Viscotears SDU( Consultants in the UK I have found dont care about Dry Eye and he said come back in 6 months )

I have now had several infections Conjunctivitis , severe Blepahritis and more eye pain .
Question , the Viscotears is a gel and does leave a sticky deposit on the eye lids could this be blocking the Mebonium glands and skin pores causing infections .Anyone have similar problems with Viscotears.???

[Jenn1]

Viscotears do seem to irritate the eye lids more from my experience also. Try lacri lube instead.

[littlemermaid]

Tony ~ Have you been able to find an ophthalmologist more skilled on eye surface disease? Keep re-presenting looking awful - this is your one working eye. Have they treated the infections well?

If local anterior segment consultants are no good, then we travel to regional teaching hospital eye specialists running anterior segment clinics with current dry eye and blepharitis management protocol and expertise (use Google or DrFoster or trace their research through PubMed or, even, NHS Choices). You may be far, far better off there if there's no one local.

Very careful handling is what you deserve. You may be eligible for patient transport or reimbursement of travel costs (phone Patient Liaison for help). If you can't get sensible NHS referral to a specialist tertiary referral eye clinic, you can see the anterior segment consultant you want from there in private practice surprisingly quickly for advice (£135-180) and stay on the NHS waiting list. This would by-pass the 'system' and probably in your case be a way into his/her NHS practice.

A doc who does not treat your one eye with extreme sensitivity and care is a waste of NHS salary You have a right to a specified management plan (search NHS Constitution).

If infections still reoccur after short courses of antibacterial drops or ointment, they can use oral antibiotics - are you still on doxycycline? If this doesn't clear it and you have recalcitrant re-infecting MGD, it can be managed with a long-term topical antibacterial regime which varies according to flareups (eg we vary from daily chloramphenicol PF to 2/wk for maintenance + Celluvisc + FML for inflammation as needed on a tapering regime + Cyclosporine to reduce steroid use).

If it is obstructed blepharitis, you must also continue improving the MGs with warm compresses and cleaning, maybe take fish oil, and maintaining the eye surface with tear film substitute eyedrops and eye protection.

If baby shampoo works for you, good, but if you're not comfortable with detergents, there are alternatives. Some people just gently rub their eyes in a warm shower or use a clean steamy flannel once or twice a day to keep the MGs moving and prevent reinfection.

However, keeping in mind there are often developing allergy/hypersensitivities in recalcitrant MGD in long treatment so you might want to work out with your ophth whether hot compress or detergent lid hygiene is still helpful. The antibacterials and antibiotics also help control inflammation. Using Celluvisc from the fridge might help with relief.

I would've thought rather than Viscotears clogging your glands, that it's untreated MGD + eyes naturally more dry. A combo that needs careful attention.

Moorfields chronic reinfecting blepharitis patients seem to be self-managing these days once we've got the prescriptions (eg we were given 4m follow-up paediatric ie 3/yr). Your case deserves careful monitoring. Untreated blepharitis is not just painful but also sight-threatening.

Ask for NHS glaucoma assessment locally. Dry eye pain is just not one of their current 'performance targets' like glaucoma - it would be if Andrew Lansley had it

If you present to an optician, their regulations oblige them to refer the disorder they see to an ophthalmologist urgently. You need regular follow-up in a good anterior segment clinic, and this is one way to get referral where you want to go if the GP practice is unhelpful.

There is no medical reason in the UK to suffer unmanaged chronic blepharitis, especially not you. But it's not so easy to access help these days in our poor disorganised underfunded NHS. But it is there. Have you got someone really pushy to help you access the treatment you deserve? There will be eye surface and inflammation damage to be healed.

How are you getting on?