Need Expert opinion on red patch and broken skin on eyelid margin (PICTURE) ?

[HYPERHEAD]

Hi,

Basically i have noticed a red patch inside my upper eyelid and what seems to be broken looking skin that is usually white over the meimobiam gland orifices ..i hope im making sense

It isnt sore or painful and im wondering if it caused by the eyelid abrasing against my dry eye as i havent used drops frequently lately due to side effects.

Is this serious and will it heal back to normal as im a bit worried, i tried green tea bags tonite to possibly help.

Please help and thanks

[HYPERHEAD]

Also could this have been caused by using johnsons baby shampoo or ocusoft lathered up on the upper eyelid lashes as some was leaking into my eye?

[Jenn1]

It does look irritated to me also, kind of like a mouth ulcer type blister. I dont do the lid cleaning myself, apart from using a wet wash cloth and gently wiping the top and lower lids and along the lash line because I know anthing more is too harsh on the skin, even cotton buds. I think you should let the skin heal and avaoid that area for a while and see if it heals up ok before continuing.

[MaryVa61]

Just in case it's the culprit, or adding to the irritation, you might check the ingredient label of your baby shampoo and see if it contains Quaternium-15. It may or may not in the UK. Johnson's makes 2 versions and I've seen that UK pharmacies online don't necessarily carry the same version, according to the ingredient lists. Q-15 (formaldehyde-releasing) can be an irritant and I have an allergy (type-IV hypersensitivity reaction) to it that really inflames my inner lids.

Mary in VA

[littlemermaid]

Is the base of the eyelashes a bit sore too? Moorfields are currently calling chronic bleph Staphylococcal hypersensitivity unless you think you've got sensitivity specifically to demodex as well... In our case, it's sensitivity to lots of things, as everyone says and we all know. I can't see a reason to use a detergent or wreck the tear film and the pH. We are just using warm compress, esp flannel in the bath or shower, and it clears the glands well. Didn't you have a problem with oral antibiotics, and also topical antibacterials, when you tried to clear the mgs that way?

Did CG see the red patch? (in case it's an unusual infection)

[NeedMyEyes]

Lid Wiper's??

I would like to suggest Lid Wiper's Epitheliopathy. I have these red patches on my inner eyelids as well and they have become more prominent since I have stopped using eyedrops (because of too many side effects). It is supposed to come from the dry tarsal eyelid rubbing against the dry bulbar surface and rubbing off the epithelia of the inner eyelid.

Dr. Korb in Boston discovered this, I believe. I have read a paper of his that says
- use a petroleum based ointment at night, Systane balance during the day.

Don't know for sure if you have LWE...

[HYPERHEAD]

Hi all..

I have the UK version of johnsons baby shampoo which doesnt contain Q-15 (formaldehyde), but i think the baby shampoo is getting into my eye and disrupting the already unstable tearfilm and causing further eyelid redness ..but i do find it more effective than ocusoft original for degreasing and removing crust when you lather it over the crusts for a few minutes.. but with the disadvantage of red eyelids and further dryness.. WHY IS IT NEVER SIMPLE

Yeh mermaid i had problems with antibiotics eyedrops but havent tried doxy?

Wanted to mention since removing a lot of the crust im now left with red skin marks under my eyes were the crusts were.. will these go back to normal or have the crusts damaged my eyelid skin

My main goal is to remove these bacteria ridden crusts and then unblock the glands , so it looks like i will have to use heat compresses again Will the heat take these crusts off quicker and will it make my eyelids very sore when these stubborn crusts are removed

[littlemermaid]

I know what the difficulty is with these tiny yellowish crusts at the lash base, we have this. Are you still able to use a warm shower? It's the warmth of steam that seems to loosen this for us and it sheds without too much poking about, so you may not need a hot compress to achieve this, esp if hot compress is making inflammation and pain worse. Oil might be an alternative to detergent if you feel you really need something. We are finding minimum intervention is best with this increasing sensitivity to all sorts of things.

What if bathroom products or house allergies were making your eyes increasingly sensitive? We've dumped everything except basic fragrance-free soap, and we're experimenting with shampoos with the very least chance of allergy to ingredients. Most people I've talked to with eg dermatitis, eczema do this (we are dealing with inflammatory rosacea).

On sensitivity to eyedrops, we are now saline only because of this. Very comfortable, so you might be ok with eg pf saline Minims (haven't looked for Alcon Unisol).

Good to see you, NME. That soreness looks so painful. How dry would the eye have to be for that to happen. I'm also finding that now LM's eye surface is less sensitive to distress, she doesn't feel a prompt to maintain the tear film, so maybe this is part of the problem, not realising just how dry the eye is, not using wraparounds, humidifier etc.

Hypes, You haven't got any doc support and CG was a non-starter. Any chance of some more out-of-town doc-shopping for better advice on helping your eyes improve? It's skill we look for. Are you seeing SW regularly now for checks?

[MaryVa61]

There are other ingredients in the baby shampoo that can irritate or that you can be allergic to. Just one example is fragrance. Do you water down the baby shampoo first? I always did best at getting rid of those crusts if I wiped the area gently during the end of my shower, with a clean dye-free washcloth that I only used on my eyes and with no cleanser in it. After showering I used plain saline wound wash (just salt and water in the right balance) on a cotton swab to gently wipe the lid margins.

If you want to test whether there is an actual allergy specific to the baby shampoo, stop using it for a week and use just plain saline to cleanse around the eyes (after showering). If you have improvement in the redness after 3-6 days with no shampoo you'll know.

I know this may not be your issue, but your lids look much like mine did, and I can tell you that if it's a type-IV hypersensitivity to chemicals, like I have, it can gradually get much worse. My hypersensitivity was to the shampoo used in my hair and it would somehow get into my lower lids during a shower no matter what I did to try to prevent that.

Another experience I had was that when my eyes were bad I did better with Ocusoft Plus foaming lid cleanser than regular Ocusoft. Not sure why exactly, but the ingredients are different and something in regular Ocusoft was irritating to my eyes. I now just use saline and without the allergic reactions there is very little goo anyway and no dried crusts.

It's good you are searching for answers. You'll eventually find them. I wonder if it would help you to visit a good dermatologist? Some treat lid issues. If you try it, I wouldn't work hard at getting rid of the crusts the morning you see the doc. The doc may need to see the crustiness. It's a longshot though since many derms don't do well with lid issues, especially inner lids.

[Tanner]

Did you do this in your sleep. nails, pillow

[HYPERHEAD]

Thanks for all your replys

I think the redness was definetly caused by baby shampoo as my lids are less red since stopping 3 days ago, crazy thing is the only thing that prevents the redness now is just using santex zero body wash its great and doesn't cause any eczema patches or red eyelids. Another thing I find irritating is massaging the lids...does anyone know what's the least amount of time you can spend massaging your eyelids after a shower to minimise irritation as I usually do it for 15 seconds per eye also what area of the eyelid do you have to massage does it have to be the whole eyelid or just the edges where the lashes are.

Another thing is when I do lid scrubs I sweep over the area with a cotton swab about 20-30 times where the crusts are and I can see the lumps turning into stringy bits that move along the margin that are really hard to get off with just warm water so i use my nails and that seems to shift them a little and I then where I sweep the crusts it becomes all red.. is that normal or am I doing to many sweeps along the margins...how long would you suggest doing the lid sweeps as I thinks it's proving very difficult removing the crusts with this method as there's some very stubborn one that won't shift especially right on the edges of the lids.

Also my upper lids are developing itchy dry skin between the lashes now which I scratch of with my nails sometimes but have stopped due to causing tiny yellow oil filled cysts on my lid margins.Also I'm losing a lot of eyelashes on the one upper lid and I do hope they grow back I'm wondering if this caused by the dry skin blocking the eyelash follicles? Can these bits of dry skin that itch only be removed by heating and softened then scrubbed off with a flannel or can just lid scrubs alone with warm kettle water remove them..Also how does a product like occusoft or sterilid actually work in removing crusts .?

Maybe I should try blephasol and blephagel as don't they have a micelle solution that helps remove the crusts ?

[HYPERHEAD]

More questions..

Hi Mary ...how did you get rid of your inner eyelid inflammation as you say your lids used to look like mine and did it completely heal up?

Unfortunately I have just developed really swollen red and greasy blurred feeling eyes after using asda dry eyedrops (1mg sodium hylauronate) and just applied some green tea bags to my ees You know what I seem to get worse eye problems when I start using drops again!

I think I'm going to try systane balance to help with this inner lid redness as dr korb recommended...and try supplementing 300mg of NAC per day along with my usual probiotic multi vitamin and vitamin c .

I'm also wondering if I should visit my GP to tell him about the inner eyeld redness and crusts.

[dijon84]

Hi
I have seborrheic blepharitis - this type of blepharitis involves greasiness on the eyelashes. My eyelashes tend to clump together, especially the upper eyelashes. It can end up looking like I only have about 10 upper eyelashes because of the clumping together! Not sure what your exact diagnosis is, but for my condition, I have found baby shampoo to be unhelpful. I use Blephasol and Blephagel currently. I apply Blephagel at night, leave it on overnight, then wash off in the shower in the morning. According to my optometrist (Sara Ward), Blephagel binds with the greasy deposits to help clear them away. I have no reason to dispute this. Blephagel seems to be helping keep the eyelashes clean.
Recommend that you go to your GP / optometrist / ophthamologist to get advice on your condition.
Dave

[MaryVa61]

Hyperhead,

I think seeing your GP or a dermatologist (or both if necessary) is a really good idea. You could have a type IV hypersensitivity to some chemicals that are in some eye drops or some shampoos, or maybe even some seborrhea (sp?) or something else.

What got rid of my problem (95%) was getting skin patch testing from a dermatologist for type IV hypersensitivities. It revealed the problem I had with certain preservatives, so I now avoid them in any products. When I was having reactions, my eyes were also super sensitive to some other preservatives in eye drops even though I'm not actually allergic to those. Those were irritant reactions.

My eyes cleared up when I eliminated the chemical allergens that I tested positive to. Then I experimented with many different lubricating drops (bought about 20 of them) until I found one that helped rather than hurting. I also eliminated all BAK products (in eye drops, nasal sprays, toiletries, etc.).

It worked for me. Google "TRUE Test panel allergens" to see the substances that a dermatologist can test for, if you think that may be the problem. You can click on the name of the substance for more info, even though they don't look like links.

Oh, and I gently wiped the lid margin area with a wet cotton swab for 6 swipes during "eye scrubs". I still do it, but I'm now sometimes lazy and only do 3 swipes since there isn't all that stringy mucus now.

Mary

[littlemermaid]

Are you seeing SW regularly now for checks?

Hyper, I thought you liked Sara Ward? Sounds like she is really helping Dijon84. You will feel much better with some regular optometrist support. And she can refer to the hospital as needed.

I'm also wondering if I should visit my GP to tell him about the inner eyeld redness and crusts.

Yes, you need to keep turning up at the GP with these sore patches to get a decent NHS ophthalmology clinic referral and ongoing treatment. I am finding I need to take a short summary of the condition to any GP, maybe the article below. And check out/print the NHS clinical guidelines on GP referral for dry eye or conjunctivitis or blepharitis (you are over 3m unresolved).

This is a good summary from OSNSupersite Cornea/External Disease (just register if you need to). It explains how the untreated mgd, allergy and random eyedrops are changing your cornea and reducing your tears. Please read the rest of the article, it's really good and it did remind me of you.
http://www.osnsupersite.com/view.aspx?rid=96106

Inflammation in aqueous-deficient dry eye is primarily T-cell mediated. T-cells infiltrate and damage the lacrimal gland, creating fibrosis and inflammatory components in the tear film, Eric D. Donnenfeld, MD, OSN Cornea/External Disease Board Member, said.

“Instead of having a normal tear film, which is supportive of the ocular surface, pro-inflammatory cytokines and inflammatory markers are secreted by the lacrimal gland, which further damage the ocular surface and start an inflammatory cascade that cycles, creating a worsening of the ocular surface and results in corneal anesthesia,” he said. “The inflammatory markers on the ocular surface damage the epithelial cells and cause further inflammation and reduce goblet cell density so that the mucin component of the ocular surface is damaged as well.”

Inflammation of the lacrimal gland leads to diminished tear production and a propagation of inflammatory mediators on the ocular surface, Dr. Holland said.

In evaporative dry eye, inflammation is largely attributed to a metabolic breakdown of lipids in the meibomian glands, with fatty acids obstructing the glands and hindering their function.

“The lipid metabolism is changed in meibomian gland disease from unsaturated fats to saturated fats that clog the meibomian glands,” Dr. Donnenfeld said. “The meibomian gland orifices eventually become clogged and lose the ability to function, resulting in permanent scarring of the meibomian glands.”

MGD involves a variety of changes that can lead to superficial punctate keratitis and Salzmann’s nodular dystrophy, Dr. McDonald said.

“The meibum is altered from its normal, clear fluid state to a pasty, yellow-white material that is highly inflammatory and toxic to the ocular surface,” she said. “In susceptible patients, this results in elevated white scars on the cornea that can decrease vision and lead to corneal ulceration, neovascularization, a host of things. Then, without the proper meibum to protect the tear layer, there is evaporative loss of the tears, which become hyperosmolar. Hyperosmolar tears are very damaging to the ocular surface, so things just keep spiraling downhill.”

...

Listen to MaryVa61 and everyone about the allergies! And check out Rebecca's blog yesterday and Scout's advice on household allergies linked in there (basically, allergens are everywhere) http://www.dryeyezone.com/talk/entry...645#comment645

I totally sympathise about the difficulty of getting a doc, any kind of doc, who has the first clue about this - ophth, derm, allergist, optom. I really think you have to keep trailing around looking for help as well as self-treating. Sorry about £ wasted on CG private; I strongly advise you find and get referral to a surface disease clinic in an NHS hosp service and stick to them like glue for follow-up, even if it's his, just to get free ongoing advice and checks.