FML has helped tearing

[saveyoureyes]

Just wanted to share this.. I have been on FML drops for almost 2 weeks and my excessive tearing has subsided in both eyes. My eye(s) have been tearing since August 2009 with no relief. TObradex, alrex and cromolyn did not help the tearing for me. I will be on FML for another week and am weaning myself off according to dr.'s instructions. I am also using Refresh Plus artificial tears (non preservative).

saveyoureyes~
Had LASIK in 2000

[ringo]

FML has helped me tremndously especially in combination with cyclosporine. I have been on it for months under doctor's supervision. It seems to be a very mild, but very effective steroid. It has the potency of dexamethazone(of tobradex) without its side effects.It somehow helps dry eye inflammation more than other steroids, and it is suitable for long term use in non steroid responders.

[stella]

do you use the version of FML that contains BAK ?
I have had a bad flareup for 2 weeks now (after 2 whole years of respite )I thought i had it permenantly under control - but there we go

I have unopened FML in the house and am thinking of using it Mine contains BAK
What do you think - would it be alright for a short time?

[lizibet]

Fml

hi guys,

Just wondered what is FML, must have missed previous threads as have not heard of this. thanks liz

[littlemermaid]

Fluorometholone ophthalmic suspension (FML)

Stella! Check the Expiry date on the bottom of the box (our new FML drops are only safe for 2 years). It is a steroid so you need to see the doc (hopeless as they may be) to make sure it's not eg viral, fungal infection first (disaster if you use steroid). Oh Lord, I know it's not easy.

http://www.medicinenet.com/fluoromet...on/article.htm
http://fdb.rxlist.com/drugs/drug-116...+Opht&source=0

FML® (fluorometholone ophthalmic suspension, USP) 0.1% is a sterile, topical anti-inflammatory agent for ophthalmic use. Active substance is fluorometholone 1 mg/ml.

The other ingredients are polyvinyl alcohol, benzalkonium chloride, disodium edetate, sodium chloride, sodium phosphate dibasic heptahydrate, sodium phosphate monobasic monohydrate, polysorbate 80, sodium hydroxide (for pH adjustment), purified water.

Some drug info. doesn't mention: 'Gently press your finger to the inside corner of the eye (near your nose) for about 1 minute to keep the liquid from draining into your tear duct.' ie influencing adrenal gland and immune system. Shouldn't be able to taste it.

Intraocular pressure must be checked regularly (1 in 10 glaucoma reaction).

Eye inflammation would be terrible without steroids, but we need to be aware of risk of side effects of longer term use and monitor for them; and how to taper dose on withdrawal (littlemermaid had nasty steroid rebound inflammation with wrong tapering instructions - too fast - she is now reducing every 4 weeks rather than every 2 wks).

[stella]

Thanks for reminding me about expiry dates - actually my unopened FLM HAS expired
Info for us in GB
I was at my GP today and after studying an up to date MIMS myself (pharmaceutical index) I discovered [B]Maxitrol ointment and Sofradex drops are [/B]the only 2 steriod+antibiotic eye preparations listed that do not contain BAK so i went armed with this info He simply asked me which one i prefered to try and i decided on the ointment and i came away from the chemist with it half an hour later

I do not intend to use it yet but am glad to have it in reserve

I have started back on Doxycillen after being off it for two and a half years
It helped me back then so hopefully it will help again
My regieme for doxy taken as vibramycin D -which is a dispersible tablet at 100 mg per tablet is ---
week 1 --- 100mgs daily
weeks 2and 3 --- 50mgs daily ie 1/2 a tablet
weeks 4 on ---1/4 of a tablet
remaining on this maintainance dose for several months

If that is not helping I will try the ointment on lid margins at night for a while

Any comments anyone on my self prescribed regieme?

Oh i forgot to tell you what is in the ointment
MAXITROL eye ointment =
dexamethasone 0.1% and neomycin sulphate 0.35%
SOFRADEX eye drops =
dexamethasone 0.05%+framycetin sulphate 0.5%
I think i am correct in saying that FLM = flurometholone 0.1% =dexamethasone (same as the above)

[ringo]

although these ointments do not contain BAK, they do contain dexamethasone which has a much higher potential to raise IOP than FML, plus a much higher potential to form cataracts. That is why it is not suitable for long-term or frequent use; and with dry eye inflammationcourse of 1-2 weeks just don't do anything much. Also the potency of dexamethasone is not high.It is, so to speak, a rough old steroid.Beware with it.It does not do much for dry eye.At least from mine an many doctor's experiences.

I would not worry about BAK too much; it is in almost every medication that helps dry eyes; and I am not ging to stopa medication just because it has BAK. Seems to me the benefits of taking the medication way outweigh the potential irritations from BAK. BAK effects are overexaggerated anyway.

[ringo]

just forgot to mention-- steroids in general, incl FML, have a drying efect on healthy eyes. However, paradoxically, because they suppress inflammation in dry eye, which is the major cause of dryness, dry eye patients experience better tear secretion with FML. Non dry eyes woud experience a drying effect from the steroids.

[stella]

Hi Ringo
Thanks for your comments
I would be VERY cautious with steroids
I had not realized that steroids dried the eyes even more

I have an article which states that minims do dexamethazone single unit drops 0.1% and describes these as fluorometholone ,so i take it that they are the same thing ?In which case my ointment is just FLM 0.1%with an added antibiotic

I would go to my optician to get my IOP done regularly IF i went on it
I suppose it is just reassuring to know there is something in reserve if one gets desperate

Are you medically connected? I notice you have Sjogens so you are probaly much worse than me and speak from bitter experiece
Anyway thanks for your comment and i will take them on board

Also regarding BAK -- Unfortunately(or fortunately) i am definately allergic to that stuff or at the least my eyes dont tolerate it at all
It means I am limmited in choice

[Guest]

Although they are both steriods, dexamethadone is NOT the same as fluorometholone....

[ringo]

Dear Stella,

Let me say this-- EVERY drop apart from non preserved artificial tears (even though in some bad cases they also irritate) initially hurts, stings and really pains a long standig dry desiccated inflamed eye: even FML and especially Acular hurt teribly in the beginning when i started using them; restasis and anything that contained cyclosporine was killing me with stinging and pain.

But that is a phase that lasts only until the inflammation is moderately under control; like now if i cry and instill drops, they still hurt as the eye is inflamed and irritated. After inflammation subsides to some extent, the drops do not hurt any more. That definitely is not from the BAK; and whichever doctor is trying to explain away your discomfort and painful eyes with BAK is just throwing dust in your eye, meaning he is trying to evade having to really explain something he does not understand well himself, as it seems with dry eye understanding comes only from first hadn experience.

Also, never confuse dexamethasone with fluorometholone-- dexamethasone is a very rough steroid which can raise IOP in no time skyhigh with very little benefit for the actual inflammation; it is suitable for inflammation other than dry eye, acute inflammation due to other kinds of eye diseases, and is used short term. FML is a very mild steroid which has shown very very little potential to raiseIOP even over long time. It does affect strongly dry eye inflammation.

Dear Chemia,

I am sorry to hear about your reaction to Alrex. Either your inflammation was severe (which means you needed something slighlty stronger and with greater frequency over a significant period,coz sometimes IOP rises due to inflammation actually))

or you are what doctors call "a steroid responder" , meaning that steroids can't do you mcuh good as your IOP will riseno matter how mild the seroid or how short period u are using it.

That is a big hurdle in edaling with inflammation, but your alternative option is topical immunosuppressants, and of course in much stronger concentration than restasis which is just a bit better than non preserved artificial tears.

Also I find that adding even one tablet of pilocarpine after putting FML makes a world of a difference to lubricating the eye, the eye lubricates profusely within half an hour;
plus (note that!) it prevents IOP from rising/lowers IOP. Another thing that helps tolerating steroids/immunosuppressants is Acular, which also prevents rise in IOP. Acular may sting in the initial stages of fighting inflammation.

It also helps against inflammation and mucous plaques, just like FML which actually expels the mucous stringsout of the eye. Acular prevents allergies.
By the way my eyes are plugged-- helps preserving the tears plus medicationsdon't flow out through the tear ducts.

Note that like doctors like to say, dry eye turns out to be a truly "recalcitrant" disease, "refractive" to most available treatments. It takes time for medications to work, and they tend to work in synery, meaning only one medication at a time produces close to zero lasting benefit.

It took me a few months to notice lasting benefits from my regimen; and in the first coupe of months a lot of stinging and disappointment from setbacks and lack of fast progress.

[ringo]

If you are a steroid responder you are right to stay away from steroids, and try immunosuppressants instead.

Even a mild steroid may create poblems for your eyes.