Any insights?

[lemonjelly]

Hi

This is my first post. I'm here on behalf of my Mum who has blepharitis/dry eye and I wanted to tell her story and see if anyone has any insights/advice for me.

She is 79 years old and at the beginning of the year, she had radiotherapy for a rodent ulcer on her nose (skin cancer). She had to go to the hospital every weekday for 10 days and had a short burst of radiotherapy each time (about 1.5 mins each day). Towards the end of this period, she started to have problems with here eyes and she did ask if it could be the radiotherapy and was assured that no it couldn't.

Her eyes worsened (terribly) and she was diagnosed with blepharitis and has been back and forth to the hospital ever since. She's been on anti biotics and predsol and artificial tears. She seems to respond well to the predsol and be a bit more like her old self. She's currently taking it twice a day for six weeks (initially it was four times a day). She's a lot better in herself but still can't see clearly. I'm concerned that when she stops the predsol, her problems will come back. She also does the eye bag twice a day.

Mum also has glaucoma and puts in three lots of drops a day. I've been working on the assumption that the preservative (BAK) was causing her problems and finally she is now on preservative free drops. Annoyingly though, the hospital continue to give her antibiotics and other drops which contain predsol which seems a bit daft to me. She's never really had the chance to be completely preservative free.

We're aware that predsol is not good for glaucoma sufferers as it can raise the pressure. Interestingly though, last time she had the pressure checked her pressures were the lowest they'd ever been.

So I've been assuming it's the BAK but I've recently realised that dry eye is a known side effect of radiotherapy for head and neck cancer and am wondering now if it was the radiotherapy. It seems too coincidental for it not to be. So can anyone give me any advice/information about this? Is there any way of addressing her eye problems if it was the radiotherapy? How does it affect the eyes? Any help is much appreciated.

Thanks for reading.

[Spoon]

Hi. Sorry to read about your mums eye troubles. I tend to agree that the radiotherapy was probably what tipped her into a dry eye state. As you have found it is a known side effect of radiotherapy however I suspect that given her age and that she uses glaucoma medication her tear film wasn't very robust before the radiotherapy. I don't think there is any therapy or approach tailored to a dry eye problem caused by radiotherapy.

I suspect that if the radiotherapy caused damage to the systems that produce the tear components the damage may heal but unfortunately with dry eye there often is a perpetual state of inflammation increasing dryness and dryness increasing inflammation, sustaining dry eye even if the initial problem is resolved. I suggest you ask for the meibomian glands to be expressed, at least so their health can be evaluated and it will also likely help with the dryness. A more specific diagnosis than just blepharitis will be helpful to get the most from the recommendations on this site. Unfortunately it's a hard thing to manage but since she hasn't had dry eye for that long I'm hopeful it can be brought to a mostly comfortable level. It sounds like you are aware that predsol/prednisolone is definitely not a long term solution.

[lemonjelly]

Hi Spoon

Thanks for the reply. I've got a couple of questions if that's ok?

I'm finding it difficult to find a lot about radiotherapy as a cause of dry eye but I believe it can damage the tear glands or the tear ducts. Do you know if this is right?

How does meibomian expression work? Is it a simple procedure?

And when you refer to a more specific diagnosis, how would I go about this? Do you mean the diagnosis could be something like damage to a particular part of the system such as tear glands or ducts (as a result of radiotherapy?).

Would the consultant be aware of radiotherapy as a cause of blepharitis? I don't go with Mum to the appointments, my Dad goes with her. They seem to think quite highly of the consultant and are happy to follow her advice but do they try to investigate the cause or just treat what they are presented with? She's just been told it's a lifelong thing that just 'happens' and she'll have to deal with it through good eye hygiene. The other thing that bothers me is that they continue to routinely prescribe preservative based eye drops when the academic literature contains many articles saying how harmful these are. Are consultants unaware of this???

[Spoon]

There appears to be a few studies showing dry eye can be brought on by radiotherapy near the eye, due to damage to the lacrimal glands. Google dry eye radiotherapy and you should find them. I don't know if there is any way of verifying that this is the cause or if there is any value in that, because I'm pretty sure it wouldn't change the therapy approach. If she is using drops often then preservative free is the way to go. Meibomian expression is applying pressure and ideally also heat to loosen and clear the blocked glands. By more specific diagnosis I mean what is the specific type of blepharitis, what is the health of the meibomian glands, tear break up time, how much aqueous deficiency etc. It should help her find a more targeted approach to treatment.

[lemonjelly]

Thanks Spoon.