A newbie with foamy tears and about zero patience left.

[shannon]

Hi All,

I've been reading this site for a while now and your wisdom and strength have been invaluable to me. This is the first time I'm posting and I just want to take a minute to introduce myself and tell you a bit about my story. I invite you to give me advice that you might think is helpful or to share your experience with me, especially if you're struggling with a similar eye issue. It's been really hard working with clients and looking them in the eyes when my eyes are constantly foaming. That's right. Froth froth froth. Mostly my eyes look and feel fine (except for some hard days) but they are pretty much constantly foamy in the outside corners.

I've always had allergies and my eyes were dry and itchy for a long time before the foaming began. Over a year ago I moved into an old house that had been completely renovated and after the big, dusty move my eyes turned completely bloodshot and I went to the doctor and they gave me antibiotics and steroids and didn't tell me much about my "condition" except that I should clean my eyes with baby shampoo and do warm compresses. After the course of antibiotics and steroids my eyes began to foam. Since then I have tried everything. Well, almost everything. My current regimen is based on Dr. Latkany's eye spa:

I use preservative free eyedrops throughout the day
Lid scrubs once in the morning and once in evening after compress/warmth of shower
Warm shower and light lid massage in morning
Warm compress with Thermoeyes beads at night
Omega 3s
Diet with no corn, wheat, soy, dairy, nightshades (tomato, eggplant)...I cheat sometime but I'm cleansing right now to check out dietary allergen possibilities.


As with most of you this has been a slow, painful process of discovery and trial and error and bad doctors and good doctors and discipline and depression and anger and frustration and hope. I live in the San Francisco Bay Area and I finally went to see Dr. Mandel (he has a Lipiflow) who was wonderful and who said that my eyes weren't so bad and that I should keep following my regimen that's based on Dr. Latkany's prescribed eye spa regimen and come back in 6 months if I wasn't getting better. (I liked that he didn't overprescribe meds and he definitely said that I'm not bad off enough to do the Lipiflow.) Well, it's been 3 months and while I see some improvement I'm still foamy. It's so disheartening. What is up with this foam?? Anyone ever experience this? Some days I feel like nothing will ever change. I made an appointment with a local doctor just to get a third opinion before I go back to Dr. Mandel. I see her Friday. I'm much wiser than I was a year ago but I'm so freaking frustrated. Most people complain of a lot of other symptoms but I just have the foamy/teary eyes...and I've started to get eczema near my right eye (I think this could be stress or product use...it started long after my eye foam started). I was told my eyes weren't even that dry, just that I had plugged meibomian glands...MGD. I can see the puffy meibomian glands in my lower right eye and I just keep thinking that there's probably a low grade infection in there...and wondering when I'm going to finally beat it. Blah blah blah. It's too much to go into here. I just wanted to reach out and say hi and introduce myself. So, hi!

Thanks again for the support and if anyone has any wisdom to share about these pathogenic frothy tears (that's what I've heard them called), feel free to message me or offer advice/experience.

Warmly,
Shannon

[shannon]

Actually...I should take that back. My right eye swells up occasionally (on the inner upper and inner lower lid..next to my nose) and the lacrimal thingy in the corner of my right eye makes noises like there is air or something trapped in it or it is clogged. I also get the eczema on the inner corner of the right eye. The lower lid, on the inside, on the right eye looks way worse than the left eye in terms of redness and puffiness...which is intermittant. I had acne and eczema growing up. The only diagnosis I have right now is MGD/Blepharitis. Sigh. It feels really good to finally be posting here. I cannot tell you how grateful I am for this site.

[gormz]

Hey shannon,

I once had some bubbly/foaminess (sp) in my tear film. My doctor said it was probably caused by a bacterial infection and gave me an antibiotic eye drop. When you think about it, that makes sense since bleph/MGD is likely caused by some sort of bacterial infection of your oil producing glands. The scientific reason for foamy material by the acanthus is that the oils of the glands get broken down into primary esters and soap, creating soapy bubbles. You could google it and im sure youd find some pics of the same thing youre going through.

For what its worth i think diet has helped me the most out of everything ive done. Dont forget to take out other common allergans such as eggs and nuts.

Hope that helps a bit

[shannon]

Hey Gormz,

Thank you for this! That's so helpful (makes me hopeful). Yes, I've seen the photos of the foam but I've never heard or read anything about anyone having foamy tears in both eyes for over a year with no real progression of symptoms and no relief from the foam. Don't get me wrong, I'm glad I haven't developed severe dry eye or the scaly crusty blepharitis. If it's as simple as a bacterial infection I'll be relieved. I've been catastrophizing and thinking that all of the years of rubbing my eyes and wearing make up have permanently damaged my glands. I've been through two rounds of antibiotic ointment in the last year and a half (erythromycin) but I think I need a non-ointment approach...the other ingredients in the ointments irritate my eyes. I may ask for Azithromycin (or however you spell it) drops. I know that people report having limited success with it for MGD but I'm getting desperate over here and have tried to do this the natural way for long enough...back to the antibiotics. I think now that I've got the hygiene thing down and I've got a good system, maybe I just need a jump start with some antibiotics? I hear you, diet has helped me immensely too. I have way less flare ups in my right eye. Yes, I'm avoiding eggs and peanuts too. And chocolate. NO FUN.

[littlemermaid]

I keep thinking that if a patient has an ear or sinus or urinary infection, they would use well-tried combination antibiotics after a good guess at what the bug is, oral and topical. And if that didn't work, they would swab. Anyone else thinking this way?

I read in Tunis Ophth have worked with microbiology to identify flora and fauna but I don't know how they accessed meibom, or whether they just swabbed the surface. I know nothing about culturing bugs but they eg identified species of Malassezia, which are cultured differently, and other various bugs. OK Tunis they have particular local flora and fauna but so does everyone inc animals in the house etc. [PubMed]

In UK we've never got further than a tentative diagnosis 'hypersensitivity to Staphylococcus aureus probably' and some attempts to pluck eyelashes for demodex although we tried a skin scrape for Malassezia. These 3 bugs are naturally occuring so a negative doesn't mean much, plus I'd cleared the Tinea with shampoos and it comes and goes through natural immunity.

So bugs in overgrowth are secondary to gunk, and gunk is improved by diet and hygiene, similar to managing eg eczema or sinus problems. But wouldn't a quick fix also include the right antibiotics/antifungals, unless it's viral? We are still maintaining once a week (not same day) with antidandruff shampoos (antifungal) and 1:50 dilute organic shampoo with tea tree oil (antidermatophyte eg demodex) just in case it helps. The Ophth thinks it probably does unless LM's eyes get too sensitive to the harsh chemicals and detergents so we are using them just once a week, TTO shampoo as a very dilute eyelid cleaner but antifungal shampoo just as a hair shampoo and letting it wash over the face in the shower. I would use Dr Scheffer Tseng's TTO/base oil guidelines if I had the go-ahead (paediatric).

I'm just thinking that for eg reinfecting swimmer's ear or athlete's foot we'd be looking at a hygienic prevention routine as well as blitzing with antibacs/antifungals on reinfection.

There has been incidence here of people fixing chronic bleph once they found out what a sinus infection was. I'm not saying it's a diagnosis, just that there are more bugs out there than the ophth are realising just now and the eyes are inside the head with fluids and tubes going all over the place and it'd be great if someone would analyse meibom for bugs in recalcitrant MGD.

Also there are obvious hormone/steroid/immune/lipid imbalances like LM, who started puberty acne rosacea in the MGs.

We are similar in that the Ophth are saying patients become hypersensitive to the enzyme products of the MGs whether bacteria products or changed sebum or the gut products of decomposing demodex (thanks Hankm). Our Ophth is seeing burning patches on the cornea if there's gunk seeping onto the surface from an infected gland. The cornea heals but if untreated there would be scarring, I guess, and changes from chronic low-grade inflammation.

Any thoughts?

[shannon]

Hi Littlemermaid,

This is also really helpful. I like the idea that it could be fungal. I've always wondered if somehow there is something systemic going on and it's manifesting in the eyes. I'm seriously allergic to dust mites which has always made me wonder about demodex and a possible reaction to the mites. We moved out of the house we moved into when all of this started, we changed our bed to a 100% natural latex bed, we use latex pillows and dust mite covers (just in case it's regular old dust mites that are contributing to inflammation). I now use all toxin/botanical free products from Cleure (rated safe by the Environmental Working Group). I'm also using products from Spectrum Thea (I thought blephaclean would help with the hyaluronic acid and it does seem to be helping). We got rid of our Ikea couch (California law requires that all couches be sprayed with flame retardant and every time I'd sit on the couch my eyes would tear and foam more). Our friend is making us a couch from an old Danish modern couch and she's using latex pillows. I've tried supplements and acupuncture and allergy meds. I'm an intern and making zero money (working for free) and my husband is a bookseller. So, we're not rich. I've spent soooo much money on this process. Ugh. I've done the tea tree oil thing and tried using SteriLid (it contains linalool, the ingredient they think is helpful in tea tree oil) it didn't seem to help much (and the Sterilid was too harsh for my skin) but am thinking I ought to give tea tree oil another try.

I have an appointment on Friday with a new opthamologist and I plan on pulling out all the stops. None of my doctors have swabbed and I may ask her to do that so we can see what's going on. I wonder if that's common practice? I'll see what she says. She could express the glands gently and swab, especially if they warm first. None of my docs have prescribed Azasite, which I'm now wanting to try. I've never taken oral doxy. I'm so hesitant to do that. I don't want to be on the antibiotics because of the impact in the gut and we're also trying to have a baby. But maybe we should put that on hold. I don't know. I'm almost 40 so I don't have all that much time (tick tock, tick tock). This all started after our big move to the old house in October 2011 (tons of dust and God knows what else got kicked up) and a round of antibiotics and steroids so I'm kind of wondering if it was somehow brought on by the meds. Could be mold, could be fungus, could be bacteria. I don't have any symptoms of fungal infection anywhere on my body...but I guess it could just be my eyes.

You've definitely given me something to take to my doctor. I think I need to advocate more strongly for more effective treatment. I'm holding up my end with hygiene and diet and compresses. I'm also going to see a Naturopath and talk about ways to go at this systemically. I'm also doing Mindfulness Based Stress Reduction work because all of this has created so much anxiety and depression. It's hard going through life with sore, sick eyes. Feels like I have soap in my eyes a lot of the time.

[shannon]

Oh...I ought to add. I'm trying to rehabilitate my gut, thinking that will improve things with my eyes. When I was in high school I took tetracycline for a long time for acne. I've been taking digestive enzymes and probiotics and things seem to be shifting there. I guess I should also say that for the first time in this whole process I think my eye care regimen is effective. I've only been doing the compresses with regularity and the correct way for about 4 months. I am still hopeful that I'm on the right track. I'll let you know what I find out and if my doctor will even do a swab/culture. That's such a brilliant idea...

Thank you.

[littlemermaid]

Hope it goes well, Shannon ~ sorry I sound a bit crazy with the fungus thing, I mean fungal like dandruff is, and people with the yellow flakes of sebaceous dermatitis use the shampoos and ophth sometimes suggest that. We have a very patient ophthalmologist but we haven't worked out how to test. We've done well on short courses of Azyter although it did sting the surface at first. Some people wipe it along the eyelid margins (as Marguerite MacDonald http://www.dryeyezone.com/talk/showt...Workshop(DEWS)). Oral or topical steroids for skin problems are known to cause the sort of periorificial dermatitis LM has and are contraindicated for that now. Unfortunately, hydrocortisone was in the Clotrimazole we used long ago when she came back from camp with Tinea versicolor on the forehead. We are seeing a dermatologist with an immunology specialism so I'll post if she suggests anything useful. I like your Mindfulness idea because we are only being offered CBT referral. Such good experience thinking about allergy, thank you.

[gormz]

Oh...I ought to add. I'm trying to rehabilitate my gut, thinking that will improve things with my eyes. When I was in high school I took tetracycline for a long time for acne. I've been taking digestive enzymes and probiotics and things seem to be shifting there. I guess I should also say that for the first time in this whole process I think my eye care regimen is effective. I've only been doing the compresses with regularity and the correct way for about 4 months. I am still hopeful that I'm on the right track. I'll let you know what I find out and if my doctor will even do a swab/culture. That's such a brilliant idea...

Thank you.

its funny you mention the gut rehab because thats what im doing. I read the GAPS diet book and started following a sort of hybrid diet of that and the autoimmune paleo diet. Nourishing traditions is also a good read on eating healthy. If youre doing probiotics it might be good to make your own (ie sauerkraut and yogurt). Both are super easy to make and have much more bacteria then youd find in a probiotic.

Lastly i noticed too that sometimes less is more. I used to rigidly follow a lid scrub routine....doing it twice a day. I noticed that once i cut down on it to once or maybe twice a week my glands seem to get clogged much less. Im not sure exactly how that works but im not complaining.

[littlemermaid]

Gormz, Yes we are similar reducing the eyelid margin cleaning with the solutions and we judge it on whether there's tiny yellowish crusting or what looks like these collarettes at the eyelash base. If things look good, we do daily warming compress and hot water/cotton wool or warm shower cleaning just with water to maintain healthy eyelid margins. If she skips, she gets chalazia again pretty fast.

I'm listening very carefully to what you guys are saying about diet - interesting that, looking back, all the docs were hinting diet advice but couldn't just say it professionally. One Neurosurgeon did say 'if you didn't eat meat, dairy and wheat you probably wouldn't have these skin probs' and hinted he could tell the colon was clogged by smell, bless 'im and the Ophth asked us to go vegetarian. The Rheumy wants us to cut wheat completely. We just saw a Neuro who suggested acupuncture for relaxation then went bright red with shame I do appreciate these very kind docs busting a gut to help us in different ways. We've been doing a 5 days off 2 days on habit with dairy, meat, wheat but maybe I could persuade LM to eliminate for a few months now she's older. We are dealing with bowel and stomach cramps like you too, and had referral for autoimmune investigations - nothing obvious, but the samples are by chance now logged with a genetic lab in case of anything interesting.

Shannon, do you have other signs of overproducing sebum like oily patches around the eyes, or persisting skin signs?

[Gil]

Hi Shannon,

I have dry eyes related to MGD and blepharitis. I used to constantly get the soap-like foam at the outside corners of my eyes. The foam, MGD, and blepharitis started to be issues at around the same time I started getting acne (circa 1993), so they must all be related (hormones). In '94, an ophthalmologist prescribed Bleph (I think it was) eye drops. They didn't help stop the foam, though. I'd often "wipe" away the foam w/ my knuckles (gently of course, better than germy fingertips) or a bandana. In 1999/2000, I became aware of how clogged my meibomian glands were. Once in awhile, one of my MGs would be completely capped.

Since 2-3 years ago, the foam has mostly gone away, and my acne isn't that bad anymore. I think it's just because I've gotten older. BTW, I'm a vegetarian and was one when I started getting the foam, acne, etc.

I plan to PM you about the doctor whose name you mentioned.

[Gil]

Hi gormz,

Thanks for this:

"The scientific reason for foamy material by the acanthus is that the oils of the glands get broken down into primary esters and soap, creating soapy bubbles."

Makes sense to me.

[shannon]

Thanks you all! Gormz, I thought about the paleo diet...I tried a low histamine diet but it was way too restrictive and not sustainable for me. I feel like the no dairy/no gluten diet is really working for my digestive system. Plus, I've started drinking an Amazing Grass/Amazing Meal shake every morning and that has really turned things around. Not to get into too much detail but let's just say that my Meibomian glands aren't the only things that are constipated. Littlemermaid, I don't have greasy patches around my eyes really. I did have acne when I was younger but my skin is really pretty great these days. My skin is pretty oily and always has been but less so now that I'm 40. I did have eczema and am prone to it so I am guessing I just have the kind of skin that goes hand in hand with MGD. I've always had weird eye stuff...like sensitive eyes, itchy eyes, styes when I was a kid.

Gil, it is good to hear from someone else who has had the persistent foam. It's such a mystery. I do have to say that I'm noticing a bit of a shift now that I'm using my eye beads (warm compresses) in the morning and evening. I can actually see the meibomian glands emptying a bit in one area (less puffy). It gives me some hope that maybe I can get them cleared out and my immune system will take care of whatever bacterial thing may be going on in there. I'm still going to the eye doc on Friday and asking for Azasite. This feels a lot like trying to cure a urinary tract infection or yeast infection...sometimes the natural way just doesn't budge it and you need the medication. We'll see.

Littlemermaid, I was once told by someone that the greatest determinant of overall health and immune system is the health of the gut. This person told me that everyone pretty much needs to take digestive enzymes (unless they are really aware of their diets and eating a lot of raw food) and often probiotics in this day and age (or eat sauerkraut and yogurt like Gormz suggested). I don't know if that's true but I can say I've really noticed a difference now that I've made an effort to work on my digestive system.

Shannon

[Gil]

Gil, it is good to hear from someone else who has had the persistent foam. It's such a mystery. I do have to say that I'm noticing a bit of a shift now that I'm using my eye beads (warm compresses) in the morning and evening. I can actually see the meibomian glands emptying a bit in one area (less puffy).

Shannon,

Yeah, I didn't know that others got the foamy stuff, too. The doctors I saw didn't seem to think that the "white stuff" I complained about was a big deal. I don't know about you, but I felt almost as self-conscious about the foam as I did about my acne, so that's why I wiped away the foam whenever I saw it. I did warm compresses, too, as well as lid cleaning (for my blepharitis), but neither seemed to help, so I stopped. I forgot to mention earlier that I'm also allergic to dust/dust mites as well as pollen. I also have a bit of what I think is either eczema or psoriasis.

Best of luck on the diet. It seems very challenging. I once got tested for food allergies, and I believe I tested positive for soy and tomatoes, but as a vegetarian, I still eat them. Soy is one of the main sources of protein for me, and I really like tomatoes. Recently, I watched the documentaries Forks Over Knives and Fat, Sick & Nearly Dead for free on Hulu. FOK promotes a plant-based diet (although the importance of organic veggies and fruits, especially those on the "dirty dozen" list, wasn't discussed), while FS&ND promotes juicing. I think diet is extremely important in controlling inflammation, which causes or promotes MGD and acne.

[gormz]

gil,

id be careful with eating a lot of soy. It is a GMO crop and additionally it can disrupt your hormones. Tomatoes are also in the nightshade family so if you have a possible autoimmune issue eating them can exacerbate problems by revving up your immune system. Also make sure you get B12. Most vegans/vegetarians are deficient in it and the kind you get from vegetarian sources isn't as active as animal based sources.