FML Tapering Advice.

[czee]

My last opthamologist (lets call him number four) prescribed FML. He didn't say how long I should stay on it or that I should taper off it, and he didn't mention any of the risks, NOT... A... WORD.

From reading this forum I have learn't about the need to taper off this steroid. I used it for about ten days and it worked really well. After about a week of taking two drops a day, my eyes were pretty much normal, it was fantastic.

Not knowing any better i just stopped three days ago and my eyes became visibly irritated again (although the FEELING of dryness is much less than before).

My plan is to start taking the drops again for three days, two drops a day and then taper off by taking one drop a day for a week after that. Does that make sense to anyone who has used FML before?

Also Ive read that a lot of people have worsened dry eye while taking FML. What does an improvement from FML mean from a diagnosis perspective? MGD? Bleph?

It's ludicrous that I have to use the internet to get decent information because the doctors I have been to are totally useless and unsympathetic.

[hirentherock]

HI,
I was advised to take steriod drops when i had a surgery for ammniotic membrane transplant.
I was put on the steriod eye drops for abt 1.5 month..
the dosage was like this-
1ST WEEK-DAILY 5 TIMES
2ND WEEK-DAILY 4 TIMES
3RD WEEK - DAILY-3 TIMES
4TH WEEK-DAILY 2 TIMES
5TH WEEK-DAILY ONCE

I have not heard that, we can use it this way
1day-3 times
2nd day-2 times
then daily

I doubt if its the correct way to use steriods.U shud take advise of other ppl before u start it.

Steroids are used for combing with inflammation of surface and inner part of eyes.If u have persistent inflammation, if any detected by doctor, then u shud use it.Otherwise any type of steroids are soothing to our body, but the effect might not be a long lasting one.

I have developed some infection which is not going away by simple anti biotics.One of the best doctor of India, Mr.Virendra Sangwan had advised to use antibiotic wth FML-flarex.But i m very tentative to use any type of steroids now.So far i havent used it again after the surgery.

[littlemermaid]

Dry eye South Africa

What does an improvement from FML mean from a diagnosis perspective? MGD? Bleph?

czee: This is exactly where we were last year in UK. Fluorometholone steroid drop suppresses your inflammation, only (unless you have other identified problems it is known to treat). When I asked ophth no5 (consultant no2) for tapering instructions he couldn't give any either because he didn't know what the cause was and knew inflammation would come back yet again, not having read a journal since c1975, or ever heard of a meibomian gland. Obviously they are not up front about this.

If they haven't given you topical antibacterials, suspect they've never heard of MGD. Obviously there are other causes to be considered http://www.dryeyezone.com/encyclopedia/diagnosis.html. Assuming you've got bland tear substitute drops.

For a diagnosis we had to go to tertiary referral: in your case, teaching hospitals in Jo'burg or Cape. Even then, there may be one guy who is interested in dry eye, looking for his niche. You are looking for corneal disease or anterior segment disease specialist (not cataract business).

The other thing I do is search on corneal disease speakers at international conferences and trace it back to their research programmes in our country.

You may have tried all this. Obviously southern Africa is tough although I know there is more interest in anterior segment because of HIV. This is why I mention the private laser clinics booming in SA, who are supposed to assess dry eye before referring to their surgeons. Ironically their optometrists will have dry eye disaster pathways and may point you in the right direction. The more up to date optometrists may even give you a sensible tear film and MG assessment if you can stop them trying to flog you laser treatment.

Every sympathy to you. Hope you get a decent diagnosis soon. Meanwhile, inflammation control needs skill and judgement. You need monitoring for side effects, particularly get eye pressure checked regularly (first time within 10 days of starting). Hirentherock's tapering regime looks fast but she has very much worse inflammation and she is in skilled hands. We reduce conservatively in 2 week steps from max 3 daily after flareup, 1 week steps caused steroid rebound. But this depends on the eye condition. We can manage on 3 FML/week to keep it to a minimum (reduce chance of long term adverse effects). In the US they use pulse therapy with steroid but have other options for long term treatment.

However, this is no way to proceed, self-medicating with a steroid unsupervised and unmonitored. Please let us know how you get on. Maybe post more detail about what you've tried. PS, close tear drains by gently pressing inner eye corner for 15 secs after instilling FML, shouldn't be able to taste it, therefore any systemic absorption minimised.

[czee]

yeah, it seems that refractive surgery is the main business for opthamologists while dry eye is merely a side income which they treat in a standardized way.

the teaching hospital angle is GREAT advice, thank you. i've just done some research and Groote Schuur, the hospital that is linked to the University of Cape Town have a number of opthamologists on their staff, some of which specialize in corneal disease or anterior segment disease.

i don't know why i didn't think of that before!

wrt to the fml, im going to start taking just a single drop a day for a few days and see how that goes, i will get my eye pressure checked at groote schuur provided i can get an appointment soon.

hopefully the fact that i have only been taking 2 drops a day for a limited time will help.

[littlemermaid]

Let us know how you get on!

[Gerri55455]

[QUOTE=czee;57898]I used it for about ten days and it worked really well. After about a week of taking two drops a day, my eyes were pretty much normal, it was fantastic.

Not knowing any better i just stopped three days ago and my eyes became visibly irritated again (although the FEELING of dryness is much less than before).QUOTE]

Hello Czee, I hope you have found a solution to your problem. I came across your post while looking for stories similar to mine: http://www.dryeyezone.com/talk/showt...inging-persist!

Thanks for your response. Best, ~Gerri