Red and depressed. Desperately seeking help!

[lovestruck]

Hi Lovestruck, and everyone else reading this. I'm an Optometrist in Dallas and I work with a group of Ophthalmologists, so my training is concentrated in ocular disease and one area I specialize in is dry eyes. There are several forms and causes of dry eye. Based on your signs and symptoms it definitely sounds like Blepharitis is at least a part of your problem. I scanned many of the comments above so if anything I say is redundant I apologize. Blepharitis literally translates to lid inflammation. Blepharitis is typically caused by a bacteria that we all have on our skin called Staph., that some of us have an allergic type reaction to. This causes itching, redness and flaking of the skin. You mentioned having blood vessels on your lids, that is a very common sign of CHRONIC blepharitis, meaning this has been an issue for a while. Some people are just more prone to having the condition due to ethnicity. Unfortunately there's not a real cure for bleph., but there are good treatments to keep it at bay. I would recommend doing warm/wet compresses to loosen the debris and to dilate the glands in the lids. Follow this up by gently washing the lashes right where they come out of the lid with a diluted mix of baby shampoo and water in a 4:1 ratio, water to baby shampoo. after that rinse the lids and lashes with fresh cool water. I would do this in the morning when you get up and again before bed. You may also benefit from a low dose antibiotic such as 50 mg of Doxycycline used daily. This often works wonders in managing this condition. Someone above mentioned not to use Visine or anything else that says "gets the red out" and I agree totally. However, for special occasions, school photos etc. you can try Opcon-A (over the counter). It works wonders for getting the red out and doesn't tend to have the negative side effects of Visine etc.

I wish you the best of luck!

Dr. C

Thank you for the reply! The thing is, the skin around my lids isn't red at all... I've heard that baby shampoo works well, so I'll try it out tonight! Is doxycycline prescription? Where can I get it? So using Opcon-A doesn't make my eyes look worse after the effects wear off?

[Dr. Dallas]

As far as Opcon-A goes, yes, as with any drop that has a vaso-constrictor in it, with long term use it can lose it's effect and actually make your eyes redder if you use them too often. However, the "rebound" affects of Opcon-A aren't nearly as bad as with Visine type drops. I would still only use Opcon for special occasions when red eyes just aren't acceptable (job interview, school photos etc.).

Doxycycline is a prescription that you must get from a doctor. It can be helpful for dry eyes and bleph., and is also very helpful for acne if that's an issue for you at all.

We have a new treatment called "Lipiflow" in our clinic for dry eye. I've treated about a dozen people who had exhausted all other dry eye options and they have done very well. It is expensive at $800/per eye, and insurance doesn't pay for it. However, if you're a good candidate it could potentially fix your problem. There is a "pre-test" done called the "Lipiview" which determines if you're a candidate, that is much less expensive. [Price deleted] It too is not covered by insurance. Something to think about anyway. There are some pretty cool videos of it being done on Youtube.

[Rebecca Petris]

Thank you for the reply! I've heard that baby shampoo works well, so I'll try it out tonight!

Lovestruck be cautious with this - if you get any increase of irritation or dryness consider an alternative. I know dilute baby shampoo is commonly suggested and certainly helps in some cases BUT we also have a lot of people here for whom it is counterproductive (any soap that gets into the tear film can disrupt it further). Something gentler with no soap may be better. Personally I've always liked the Ocusoft lid scrub foam (available in most drugstores) and there are several other specialized products available for this too.

[lovestruck]

Alright, maybe I'll get a bottle of Opcon-A to use here and there. Haha acne has actually never been a problem for me, but it can't hurt. Lipiview seems interesting enough, maybe down the road if my eyes don't improve, I'll consider it.
Okay! I'll see how it feels tonight and go from there
As for good opthamologists, would you recommend any of these? http://www.healthgrades.com/ophthalm...xas/sugar-land

[Dr. Dallas]

Alright, maybe I'll get a bottle of Opcon-A to use here and there. Haha acne has actually never been a problem for me, but it can't hurt. Lipiview seems interesting enough, maybe down the road if my eyes don't improve, I'll consider it.
Okay! I'll see how it feels tonight and go from there
As for good opthamologists, would you recommend any of these? http://www.healthgrades.com/ophthalm...xas/sugar-land

Dr. Wade's office in Houston is excellent. I am actually more familiar w/ Dr. Jill Autrey, who is one of his associates. She is superb and also has a Pharm. degree. If you do decide to look into lipiflow, Mann Eye institute in Katy, TX. has one. It's actually only one of two in Texas. Dr. Victoria Chin is the doctor to see there, she is very good as well.

As for the comment from Rebecca concerning the baby shampoo, I agree. You do need to be careful to avoid getting the diluted baby shampoo in your eyes and there are pre-packaged lid scrubs you can buy that work well.

Best of luck!

[lovestruck]

Are you sure Dr. Wade is good? His reviews aren't very good... Getting to his office would be very easy for me, but I want to make sure I'm picking the right doctor.

[littlemermaid]

I scanned many of the comments above so if anything I say is redundant I apologize.

Dr Dallas,

Can I just check that you know you are talking to a minor?

She should be seen by a doctor in paediatric eye service, should she not. I am very shocked at your approach as a doctor. Particularly recommending an OTC vaso-constrictor to a child with undiagnosed red eye who has not been assessed for chronic infection.

I am thinking that as a professional it would be ethical to talk to the parents about treatments.

Please respond and clear this up for me.

Lovestruck, I'd be talking to Rebecca about paediatric ophth at this stage.

[lovestruck]

What's the difference between a pediatric opthamologist and a regular one?

[spmcc]

I too am a little leery of a few things:

(1) baby shampoo - like Rebecca, I recommend avoiding baby shampoo near the eyes. It was one of the first things I was told to do ~20 years ago, and turned out to be one of the Top Five Worst Things for me.

(2) oral antibiotics - especially for a young girl. I've been on oral antibiotics for ~25 years (diagnosed at 21yo with rosacea). This means I've had yeast infections for ~25 years too. I know that "low dose" is now in-fashion, but I would weigh the pros and cons more heavily and perhaps not start oral antibiotics so young. They do not fix the problem... you generally have to stay on them for life if your diagnosis is chronic blepharitis.

(3) LipiView/LipiFlow - I would love some comments from Dr. C on my results (see thread: http://www.dryeyezone.com/talk/showt...Dr-C-in-Dallas)

I am *not* convinced that LipiView and LipiFlow have been proven beneficial (yet?) for people with MG problems.

Note: I do not have any training/education in dry eye disease or related. I am just a person with dry eye/ocular rosacea/MGD since ~1995.

Wishing you all the best.

[littlemermaid]

Good question, Lovestruck. We've had better and more gentle attention with children's eye docs, and treatments tailored carefully to LM's eyes. I know you don't feel like a child but if you find a good paediatric ophthalmologist specialising in blepharitis, they are more likely to use this individual and gentle approach without blitzing with loads of random eyedrops and ointments. Younger children's eyes behave differently to drugs and eyedrops and need paediatric doctors. But even with teenage eyes, I would get into a paediatric environment if possible - they are so nice to you! I know paed ophth are rare as hen's teeth but it's worth asking.

[lovestruck]

Alright, I guess I'll just stick with hot compresses for now. And just to clear this up, I'm a boy. Now that I think about it, I probably should change my name :P

[lovestruck]

Good question, Lovestruck. We've had better and more gentle attention with children's eye docs, and treatments tailored carefully to LM's eyes. I know you don't feel like a child but if you find a good paediatric ophthalmologist specialising in blepharitis, they are more likely to use this individual and gentle approach without blitzing with loads of random eyedrops and ointments. Younger children's eyes behave differently to drugs and eyedrops and need paediatric doctors. But even with teenage eyes, I would get into a paediatric environment if possible - they are so nice to you! I know paed ophth are rare as hen's teeth but it's worth asking.

If I can find a pediatric ophth, I'll be sure to check them out! Yeah, I've been looking around and haven't been able to find any. But I'll ask around and see if there are any where I live!

[spmcc]

Oops. Sorry - I made a huge assumption there!

Littlemermaid is correct about pediatric ophthalmology though. I hope everything works out for you.

[littlemermaid]

It's a dude! Sorry, Lovestruck.

Why not email Rebecca and ask for her advice on good docs? Please, just so there's a plan if you need it - but don't leave the ophthalmology appointment till things get worse because there's a problem brewing.

Also, have you got some really good prescription glasses and sunglasses that you like?

[lovestruck]

I've already messaged her so I should be getting a reply soon! I have prescription glasses that I'm fine with wearing. I'm probably going to keep wearing them until I get this under control.