My first visit to the eye doctor went like this...

[Andrey]

Ok, so today I had my eyes checked for the first time. They said my tear production was good (17/18). Is it normal that someone who has dry eye has a normal tear production?

We also tested my vision and it was pretty bad so they said I need glasses. Is lenses not an option? Because I think some people here got these dry problems in the first place from lenses?

So he gave me oftagel with no preservative in them and said they could help. I tested them and they didn't really help. They are not as annoying as those drops that got preservative in them but they are still not really helping me. Is this something that could lead to even worse problems if I continue to use it?

Tell me what you think I should do. I'm considering to eat another antibiotic cure again since my eyes got so much better from it. I'm thinking that maybe I ate it too short, for it to give permanent results...

[Súil Eile]

Hi Andrey,

Your eyes may be producing tears, but those tears may have very little lubricating properties. I have this issue myself. Sometimes I can feel my eyes producing their own moisture but it's of very little benefit to me and I still need to use drops/ gel.

How long have you been using Oftagel? It might take a couple of days to notice any affect. Traumatised eyes don't always respond to treatments as quickly as we'd like

[Andrey]

Have only been using these new drops for one day so obviously it could change.. =]

Do you treat your eyes somehow?

Anyone think these drops could hurt my eyes in the long run?

[littlemermaid]

Andrey, If you first had Accutane for sebaceous dermatology, and the oral antibiotic worked to help your eyes, does that mean you have obstructed meibomian glands? Are you using warm compresses and gentle cleaning and taking fish oil to keep the glands moving? Have you seen clear meibom? Because you are thinking you have good aqueous tearing, I am wondering if it's mgd that isn't being cleared?

[Jenn1]

Hi Andrey,

You have the same as me: mgd and a normal tear film since we were both on accutane and i have had this confirmed by 3 diff opthamologists who say its blepharitis, but I know its correctly meibomian issues, just they wont admit that!!

Anyway, my routine is warm rice bag compress daily in the microwave for less than 1 minute and then use celluvisc drops throughout the day and sometimes for infection chloramphenicol. Try the celluvisc for a few weeks with the compress and lid cleaning and see if it controls your symptoms.

And for antibiotics the main two they prescribe are doxycycline and erythromycin tablets, so try a course of each via your gp and see which one suits your body and eyes better.

[Andrey]

Littlemermaid, no I'm not taking anything right now because I'm sure it won't help me anyways. I took crill oil for some weeks but didn't notice any difference, and I don't dare to test flaxseed because then I might get my acne back and it won't go away if I don't go another accutane cure, and let's say that I really don't have the energy for that. =)

What about this? http://www.eyecareeducators.com/site...ysfunction.htm

Is it easy to get this from a doctor?

I have said before that azithromycin helped me a lot and while I ate it my eyes were feeling close to perfect, but as soon as I stopped taking it, problems slowly came back. I got a PM from a nice person that told me that he/she had been taking antibiotic for 20 years for his/her MGD. I think the person took doxycycline. Is it possible to take azithromycin for years as well? I don't want to try doxy because I've seen several people saying azithromycin is better and since I know it worked great last time, I wanna try it again. I don't know what is best though, to order the pills that you just swallow or the thing that you put in your eyes. What do you think is the best option?

[Jenn1]

Try one at a time for a month each and report back by keeping a diary of symptoms and any relief/changes.

[littlemermaid]

Hi Andrey, Oral/topical, I really don't know but I'll tell you what we're doing in case it helps and hopefully somebody else might post up on this too.

It was easy for us to get topical azithromycin as Azyter (Spectrum Thea) - we used it 6 days only and it definitely helped clear the mgs but we used a steroid drop same time so not a fair test for you. Azyter thread

Do you think you could fix and maintain the eyelid glands with warm compresses and careful cleaning, maybe with an eyelid hygiene product that suits you? We are using these guys for the choice of preservative-free http://www.dry-eyes.co.uk/

Very good find - Dr Donnenfeld's helpful regime and thinking. Azyter instructions for conjunctival infection were 2/day for 3 days so ED's 28 days on AzaSite looks scary - is this normal in the US, I wonder?

It's useful to look at other doc regimes 2007 International Dry Eye Workshop, Tear Film & Ocular Surface Society & International Workshop on Meibomian Gland Dysfunction, IOVS 2011. Also PubMed search to find the latest research thinking.

Obviously, not using a topical too much in case it sets up further problems and eyes get damaged and sensitive. (We haven't used pulse-therapy oral antibiotics since LM got reactions, just means you stop them if there's problems.) I think we do best on minimum intervention to get the glands cleared, then gentle warm compress and cleaning every day for happily-ever-after, spiralling everything back to health (saline, eye protection, careful with environment). If there's another flare-up it's back on the pulse therapy drugs, as ED. Would this suit you? Of course, everyone's a different story.

Are you using anti-dandruff shampoos if you are a sebaceous type? Dermatologists are advising us use only simple pH neutral soap + hypersensitive shampoos including anti-dandruff occasionally (like 3/week). Maybe Dijon84's posts might help you if you're more a sebaceous blepharitis-type than hypersensitive.

So, hope you can work on a regime with this eye doc checking how your eyes are responding.

The diary is a really good idea - include food, activities, stress etc - looking for correlations (eg to show how individual this is, one lady told me her son discovered orange juice, banana, strawberries were triggering his acne eye/skin inflammation!) The acne and rosacea forums say it's best if people think about this for themselves - different ages, metabolisms, stories.

On flaxseed oil skin flare-ups of sebum and acne: I'm trying to read up on digestion of fats and lipid metabolism (flaxseed takes another step to conversion into the useful fatty acids we want for meibom and sebum which some people can't do - we get this and have to use fishoil). We have minimised gluten, dairy, sugar, yeast, meat products in a gentle way looking for 'inflammation triggers' - I have to say the skin looks very much better, but then we can't manage without topical erythromycin. I am sure diet affects sebum and meibom and hormone/steroid metabolism, just not quite sure what to do. We are using zero meat products except small good quality organic plain cuts or free-range poultry (eg 3/week) + eggs, definitely no eg pork fat. Lots of fish though. We are also taking multivitamin + minerals occasionally in case of deficiencies http://www.vitabiotics.com on the basis it covers many things and has a picture of a professor on it (can't get detailed testing here)...

If I ask yet another dermatologist, they say 'well, hormones, isn't it, androgens' but there's more to it. I am struggling to understand steroid/lipid metabolism but it is fascinating, it seems the answer for some of us may be there.

What do you think? Could be none of this is helpful for you. I love choosing glasses - did you get nice ones?

[Andrey]

thank you all for your answers. and littlemermaid, i see that you're giving many long answers to everyone, very appreciated.

i can't answer on every question because i don't know what some words means and i don't even know exactly what i got myself, but i guess i got the same problem as jenn1 since our problem started the same way. i ordered a rice bag and a sleep mask from this site, is there anything more i should think about buying? is it helping you jenn1?

im gonna copy the pm i got, but i wont write the persons name in case he/she doesnt want it.


I know that there are places in the world that are more cautious with antibiotics now (as well they should be). HOWEVER... if your ophthalmologist is familiar with blepharitis, meibomian gland dysfunction, ocular rosacea and more eye problems, then he/she will KNOW that oral tetracyclines (which include tetracycline, doxycycline, or minocycline) are STANDARD treatment for these conditions.

Just so you know, there are also some other names for doxycycline. There is periostat (20mg of doxycycline), oracea (40mg of doxycycline) and there is "regular" doxycycline (100mg).

Usually, you begin with a higher dose in order to "kick in" and work hard to help (so perhaps 2x100mg pills per day for 2 weeks). Then you can lower it to 100mg per day (that's what I take and have been taking for 20 YEARS!!!).

If you have access to periostat or oracea, then your doctor may feel more comfortable giving them to you. Supposedly this low dose works as an antiinflammatory and not as a bacteria killer (so you avoid the problems of resistance).

The first thing you should do is prepare yourself for your doctor's visit. Read the 2007 Dry Eye Workshop Report (http://www.tearfilm.org/dewsreport/p...DEWS-noAds.pdf).

Page 171 is where the report starts talking about tetracyclines. You can also go to the references at the end of the chapter and print out the pubmed abstract to the studies to give to your doctor. THERE IS A TON OF RESEARCH ON USING ANTIBIOTICS FOR BLEPHARITIS, MGD, ETC. Like I said above, this is standard treament... and these antibiotics are not given for short periods (e.g., 24 days). They are long term (months to years!).

Then the easiest thing to ask for would be 100mg per day of doxycycline for 3-6 months (that is unless your doctor would like to try another formulation).

Good luck to you. Just remember - preparation for your appointment is key. Take in copies of research papers showing the use of antibiotics for what you have.

------------------------

since azithromycin helped me so much im so tempted to just eat antibiotic for the rest of my life since it seems to be working for others. im just really afraid that maybe it could cause even more problems...

[AprilShowers]

I have very little faith in doxy or eye drops, after 19 years of battling this infection thats how you end up.

My suggestion is to use a warm bottle device of some sort for approximately 10 minutes on each eye, I use a rubber hot water bottle to heat the glands and for obvious reasons advise keeping your glands clean. By clean I mean not bulging with clogging-up-the tear-glands-gunk, followed by a gentle swift wipe afterward with luke-warm water on cotton wool. In the UK asking for any anti-biotics is a no-go area, UK doctors are quick to tell you it kills all the friendly germs in your body and will leave you open to infection from other maladies. If you warm and wipe maybe 2 times a week then that's ten times better that doing nothing whatsoever.

PS: Right now my grandchildren are playing with some small aluminum water bottles about 6 inches high that hikers use, they would be ideal as eyelid -warmers when filled with moderately hot water. Bear in mind our illness always returns, your looking for partial relief not a cure. I wish the standard treatment did work then we would all be cured and live ever, ever, afterwards in the Wonderful land of OZ.

[spmcc]

I'm reading a book called "Rosacea: Diagnosis and Management" by Frank C. Powell (2009). He's a Dublin dermatologist who wrote this book for other dermatologists and doctors.

Chapter 7 is on Ocular Rosacea. On page 119 he writes:

Systemic antibiotics

Minocycline, doxycycline, oxytetracycline, erythromycin commonly used.
6-12 wk therapy.
Response begins after 2 wk.
Metronidazle used rarely.
Relapse common after course of therapy completed.

I don't know if your diagnosis is rosacea/ocular rosacea, but (in my experience with rosacea and ocular rosacea) oral antibiotics are very often used for blepharitis, MGD, etc. The problem is, it seems, you need to continue on them forever.