Going on year four of blepharitis...with some ODD symptoms?

[dnc79]

About four years ago I started to develop the redness, irritation, morning build-up, etc...all of the typical bleph stuff and wasn't surprised when my opthamologist diagnosed it. He had me try azasite, bepreve, alrex, and doxy, in addition to the scrubs, hot compresses, and a couple of over the counter drops. It was mainly limited to my lower lids, including a fairly large red bump that appears permanent.

Well about a year ago I when I had the symptoms nearly all under control my upper eyelids just BLEW UP out of nowhere! At the time I was using doxy, compresses, scrubs, and a naphazoline drop on a daily basis. As soon as I noticed this I went to see my opthamologist, who told me he thought my lids looked perfectly normal and couldn't see anything wrong (later had a clueless dermatologist tell me the same). While I don't have some of the primary symptoms of bleph anymore, I know there's something wrong when your lids are constantly swollen, wrinkled, and RED RED RED. Around this same time I also lost the ability to produce tears, whereas before I usually had too much tearing.

The strange thing now is that I have no more crustiness / buildup, pain, itching, or sensitivity to wind, light, etc. I've stopped the scrubs because they really stung and would blow up my lids, and I'm even trying to wean off the compresses too. My lids actually look best first thing in the morning after a full night of sleep (almost completely normal for the first 30 min to an hour) and then get progressively worse throughout the day. Sometimes by dinner I can look like a 15-round boxer and have no symptoms other than that!

At this point I consider myself very fortunate that I don't experience the pain and discomfort that many on here have, but this has still become a serious drain on my quality of life. My last doctor suggested a rosacea connection which I have a family history with as well.

I'm here wondering if anyone has experienced similar symptoms and could provide advice for treatment. Just reading some threads here and so far I've been amazed by the amounts of knowledge and support the forum provides.

Thanks in advance for your input!

[Rebecca Petris]

Well about a year ago I when I had the symptoms nearly all under control my upper eyelids just BLEW UP out of nowhere! At the time I was using doxy, compresses, scrubs, and a naphazoline drop on a daily basis.... I know there's something wrong when your lids are constantly swollen, wrinkled, and RED RED RED.... Around this same time I also lost the ability to produce tears...

Sometimes it's really impossible to nail down just what did what so we treat the results not the original cause... I hear from an awful lot of people who get dry eye apparently out of a clear blue sky.

Are you still on the naphazoline drop? Have you ever had a break from it to see what happens?

When you say you lost the ability to produce tears... you're severely aqueous deficient? And your bleph symptoms are under control but do you know how your meibomian glands are looking clinically by chance? (Producing normal oil? no?)

[dnc79]

Sometimes it's really impossible to nail down just what did what so we treat the results not the original cause... I hear from an awful lot of people who get dry eye apparently out of a clear blue sky.

Are you still on the naphazoline drop? Have you ever had a break from it to see what happens?

When you say you lost the ability to produce tears... you're severely aqueous deficient? And your bleph symptoms are under control but do you know how your meibomian glands are looking clinically by chance? (Producing normal oil? no?)

I stopped the naphazoline after once daily usage for about 4-6 weeks (this was around last July) since I found out long-term it could actually increase redness. It was actually GREAT for temporarily reducing the redness but I suspect it may have been a culprit in the flare-up.

Not entirely sure about the glands...just know that after a pretty thorough doctor's inspection (I made him look twice) he told me that they looked completely normal and there really haven't been any changes since then.

What do you specifically mean by aqueous deficient? I drink lots of water every day, eat very healthy, and have cut down on caffeine and alcohol. The more I read the more I think this is ocular rosacea territory and not bleph.

Thanks again for your input.

[Rebecca Petris]

Naphazoline is a vasoconstrictor isn't it? Those should never be used with any regularity even on healthy eyes let alone people with these conditions... glad you found out soon enough to avoid more damage.

Not entirely sure about the glands...just know that after a pretty thorough doctor's inspection (I made him look twice) he told me that they looked completely normal and there really haven't been any changes since then.

Next time you see a doctor ask them to press on the glands and describe what comes out.

What do you specifically mean by aqueous deficient?

The lacrimal glands secrete the aqueous/watery part of the tear film (which constitutes most of it). Usually when people say their tear production is down or gone they mean their lacrimal glands aren't putting out tears, as opposed to the meibomian (oil-producing) glands which are the ones directly affected by bleph, rosacea etc. So we tend to distinguish between aqueous deficient dry eye (i.e. malfunctioning lacrimal glands) and lipid deficient dry eye (i.e. malfunctioning meibomian glands). Of course it's not that clean, since most of us have problems with both. Long story short, I was just trying be sure what you meant by losing the ability to produce tears.

[olb]

Rebecca,

my doc "pushed the meibomian glands" and oil came out. What does that mean then?

[Rebecca Petris]

Well... that's where the "describe what comes out" part needs to happen. Did it come out easily? Any blockages? What was its consistency? (As many here will tell you, a lot of people get "toothpaste" type secretions instead of normal oil.)

[Súil Eile]

Hi dnc79,

Welcome to the motley crew of DES sufferers! The irritation of your lids sounds horrible and very uncomfortable. I can imagine it has a huge impact on your lifestyle physically, emotionally and mentally.

Are you currently experiencing dry eye or is the main issue the condition of your eyelids? It may be that you have had 3 conditions, eg DE, bleph and ocular rosacea, but that now the bleph is gone? From your post, it seems as if you might be bleph free, in that you doctor didn't spot anything unusual and you no longer have the same level of crusting, sensitivity etc. I'm not a medical expert by any means, but I think it's important to be able to distinguish between several eye conditions that can occur at once.

I had bleph for 5 years but it's gone for now, thankfully! I still have DE though, but my treatment had to change as hot compresses etc don't have the same effect now as they did when I had bleph. Maybe for you it would be worth exploring the rosacea route? I don't know a huge amount about rosacea, but I imagine that hot compresses used for the treatment of bleph (that might be gone) could have a negative impact on rosacea? Do you feel any benefit from the compresses?


One of the toughest things is tracking down a doctor with the experience to recognise and treat your condition. It can sometimes feel like chasing the end of a rainbow!