lotemax with ikervis?

[Matt0029]

I had great success when using Ikervis and the steroid Prednisolone. 0.5%. My eyes were back to normal. I was producing tears and not really needing lubricating eye drops. Since stopping the steroid though my eyes have become dry and painful again. Has anyone been able to combine cyclosporine (ikervis). With a steroid for long term maintenance? Because of the success I had on steroids does that suggest my glands aren't producing tears correctly due to inflammation? I think I have read that Lotemax is a safer steroid as it doesn't penetrate the eye as well as other steroids so less side effects? I am seeing my eye doc next week I will ask him. I just wondered if anyone on here had a view on the points I have mentioned. Thanks for any advice.

[Meibum Ian]

Not sure Lotemax can be prescribed in the UK? I think a consultant said he would like me on it but had to prescribe Pred instead. I could be wrong of course.

[Matt0029]

Thanks are you on Pred. long term?

[Meibum Ian]

No, had a couple of 12 day courses early in the year. Then 1 month when I started Ikervis

[Matt0029]

Did you find your eyes a lot better on Pred. too? Ikervis doesn't seem to be enough on its own for me.

[MGD1701]

Hi Matt
could be allergy too. Good to pay attention to what you are allergic to and avoid them, maybe dust, pollen, feather, cat, dog etc. Allergy test would be good too.
Inflammation, best is from diet, avoid sugar, add omega 3 etc.

[Meibum Ian]

Hmm, looks like I might have been wrong: http://www.lloydspharmacy.com/en/lotemax-05-eye-drops

[Guest]

You’re right about lotoprednol not penetrating well. I saw a study, I’ll see if I can find it, where participants used anywhere from 300-3000 drops per eye over a 6 year period. Only one patient had any issues. So I’d say it can be safe. The biggest concern would be the preservative...if you can get it compounded, do it, no matter the cost. If not, try to get lotemax gel, it has 70% less BAK than alrex or lotemax drops...and it’s more consistent, perfectly dosed. Don’t forget to shake your dropper bottles before using any steroid.

can I also say, if you attack the cause, you shouldn’t need steroids long term. For example, I have floppy eyelid syndrome...I’m on methylprednisolone, compounded preservative free, for 6 months. The whole time I’m taping my eyes and trying to keep them from opening at night, which is the cause of my dryness. The hope is that once things are stable, when I stop the pred, the inflammation shouldn’t come back because the source of the inflammation has been addressed. Find the cause if you can...very difficult I know,

[Matt0029]

Thanks I will discuss all this with my eye doctor. The inflammation has definitely come back. Ikervis on its own hasn't been enough to keep it at bay.

[Meibum Ian]

Have you considered autologous serum / prp drops to help control the inflammation?

Unfortunately means travelling outside the uk

[Matt0029]

I think autologous serum drops are really, really had to get on the Nhs in the UK. Though there avaiable. I see my doc next week it can't come quick enough. Really struggling at present. Dry eye hugely disorients my vision plus the pain.

[Matt0029]

Hi Matt
could be allergy too. Good to pay attention to what you are allergic to and avoid them, maybe dust, pollen, feather, cat, dog etc. Allergy test would be good too.
Inflammation, best is from diet, avoid sugar, add omega 3 etc.

Well I had my follow up today my eyes were inflamed again he lifted up my lids and these were all red so has prescribed me Opatanol as the inflammation could be due to an allergy. I am to try this on its own for 2 weeks. If no improvement I then have FML eye drops to try after. We did a Schirmers test than came to 4mm left eye 6mm right eye. Think he said it was usual to see inflammation when on ikervis. So not clear cut if allergy or dryness causing the inflammation this time.

[MGD1701]

I think an experienced dr should be able to identify allergy??

Ikervis, interesting to know dr said it was usual to see inflammation when on ikervis. Anyone heard of such statement?

Schirmer - did you often get such results?

Did dr do staining both fluorescein & lissamine green because
''some have tremendous on conjunctiva but no problem in cornea'', according to Prof. Sheri Rowen
None of my doctors did both, next time I will ask both to get an accurate diagnosis. 80% of my doctors actually did not do any staining.

[Matt0029]

He said my lids are all red with implies it maybe an allergy causing the inflammation and to try the Opatanol to see what eyes are like once cleared,
There was staining on my eyes and dry spots I think just one dye was used. My Schirmers are always low. Was 2mm left and 3mm right last time. Is a normal result over 10?

[MGD1701]

Schirmer
most opinions in USA considers Tear Meniscus Height is more objective - which I believe it too as my schirmer values ranging from 0-30.

Some doctors say if schirmer with serially abnormal results (below 5?) over time are likely autoimmune diseases (sjogren, Lupus etc.)

Doctors did not recommend you visit rheuma. dr? I would, if I were you. Maybe good to do a bit research to learn more.