Need advice on how to deal with my GP!

[jads]

This is very important! I know a few people who have blepharitis and were completely unaware of it until they were examined prior to laser surgery.

My theory is that blocked meibomian glands and inflammation are caused by the slow process of deficiency of hormones related to ocular tissue health; notably androgen hormones.

This may be mild and unoticable at first because the deficiency is not at a chronic stage. Hormone levels fluctuate, so it is also highly possible that blepharitis clears up for some people without causing chronic cases of DES because the underlying hormone deficiency rights itself prior to DES taking hold and becoming more permanent.

[Súil Eile]

My theory is that blocked meibomian glands and inflammation are caused by the slow process of deficiency of hormones related to ocular tissue health; notably androgen hormones.

This may be mild and unoticable at first because the deficiency is not at a chronic stage. Hormone levels fluctuate, so it is also highly possible that blepharitis clears up for some people without causing chronic cases of DES because the underlying hormone deficiency rights itself prior to DES taking hold and becoming more permanent.

But what about the bacteria element of blepharitis? I accept that that hormone levels can contribute to DE, but I'm not convinced of the impact on anterior/ posterior blepharitis

[littlemermaid]

UK NHS referral to ophthalmologist - doctor shopping

Britgirl: I am so sorry this is happening. Maybe ask your optometrist for a hospital eye clinic referral, tell her the impact on your life, bad GP experience etc.

The NHS is 'Choose & Book' these days http://www.nhs.uk/ServiceDirectories...iceSearch.aspx through a GP. There is also the private sector at approx £180/consultation + prescription, mostly the same consultants, no referral needed. Almost like finding a good plumber but it's your livelihood and eyesight at stake. Go to appointments with a short list of questions, also so you can assess their skill and knowledge.

I completely understand how you feel about your GP, but you need to dump the dude before he does you any more permanent damage and get someone good. Fucidin is a topical antibacterial fucidic acid formulated for skin only, Fucithalmic is the ophthalmic suspension he should have prescribed. Also no GP has equipment to examine the eye.

Any high street optometrist or any GP, including the weekend cover for your GP practice, can refer you to an ophthalmologist or hospital eye clinic for blepharitis and dry eye pain, especially with the terrible impact this has had on your life.

Or you can self-refer to your nearest teaching hospital emergency eye clinic looking your worst. Say you have eye inflammation and pain undiagnosed locally, if a triage nurse asks. Once you're in there, they will treat what's in front of them.

You are more likely to get a good assessment, treatment and monitoring if you can get referral to a large teaching hospital eye clinic, more up to date and skilled. Unless you can find a good ophthalmologist in your local hospital.

Or you can see a consultant in private practice: choose from the NHS hospital list or private hospital sites, phone their private practice secretary. Check in advance that corneal specialist does not just mean cataract surgery, check they are interested in surface disease and inflammation. If you like them, you can ask for an NHS referral afterwards through a GP or optometrist.

High street optometrists offering lasik have some knowledge about dry eye and bleph assessment these days because the optometrists have to monitor and treat it, or refer it.

Do you want to tell us what region you are in? People may have useful local experience.

[y-gwair]

So sorry to hear of your problems, your experiences mirror my own (just pm'd you). I haven't been able to work for 6 months now because of severe inflammation related to my dry eye. Many years ago I was prescribed prozac for what eventually turned out to be autoimmune thyroidtis; I'm sure this just exacerbated to the dryness problems as dryness is one of the side effects. It's typical of the lazy approach many GPs take, and should never be the first line of approach before other causes have been excluded.

I've had severe problems with nearly all lubricants, including versions without preservatives. Unfortunately severe dryness is accompanied by inflammation, which can't be controlled by lubrication alone, so you really do need to see someone who can diagnose and treat your condition more precisely now.

[jads]

But what about the bacteria element of blepharitis? I accept that that hormone levels can contribute to DE, but I'm not convinced of the impact on anterior/ posterior blepharitis

Yes I agree there are cases of purely bacterial blepharitis that with proper treatment don't go on to cause chronic DES. I'm only referring to the cases of Bleph that are linked or related to MGD and lipid deficiency.

[britgirl]

thank you for all of the advice I have finally managed to get a referral! Will let you know how it goes.