Antibiotics for MGD

[dryirisheyes]

Hi all,

I am just wondeing what peoples experiences are taking oral antibiotics to treat MGD (possible ocular rosacea)?

In August of this year I was prescribed a 6 week course of Doxy - my oil gland functionality improved in this time probably by about 40%. But shortly after I finished the course my eyes reverted to being quite dry and inflammation increased in the glands again (although not as bad as before).

I am currently 2 weeks into a 8 week course of tetracycline (I was prescribed this mainly for rosacea and a outbreak of acne but I know they can also help the oil glands too) and so far I have had good results (my eyes feel 80% normal - the most normal they have felt in a LONG time). I can feel oil coming out of most of my glands and my eyes feel lubricated - the dry feeling is almost gone along with most of my other symptoms (sensitivity to light etc).

I am just wondering if anyone has had similar experiences and if the results of these antibiotics are long lasting? I would prefer not to stay on these antibiotics long term.


Thank you for reading my post.

[CharlieGreenEyes]

Hi - I've been on doxy for just around a year now. Also for MGD. My opthalmologist told me to stay on it for the time being when I last saw him a few months ago. Like you, I wasn't sure about staying on antibiotics long-term but I'm desperate enough to do anything that might help my eye problems so I'll keep taking it for now.

I've heard a low dose of doxy (20 - 40 mg daily) on a long-term basis for some people can be helpful for MGD - so perhaps that's what my opthalmologist has in mind for me (I'm currently on a higher dose - and definitely intend to ask about going down to a lower one when I have my next appointment).

Not sure how helpful it's been for me - I still don't seem to have much oil at all (or my glands are clogged or gone perhaps) but I'm fairly sure it's stopped things getting worse. Before I was prescribed it, I've been getting infections like styes every few weeks (for 4-5 months). The doxy seems to have helped massively with stopping this. I've currently got a stye but it's the first one in a year - and I think it's because I had a good crying session (which always messes up my eyes) and didn't rinse out the tears or scrub my lids or do a compress until the next morning.

[MGD1701]

How about
1) diet, such as Omega 3 & 6/GLA?

2) effective lid cleansers (with pure Hypochlorous Acid, like Avenova or Heyedrate Lid & Lash)
Both are only available in USA but maybe you could find alternatives, like me, have found 3 only last one, NatraSan, made in UK, helps.
----------------------
Just found these interesting videos (one dr also mentioned about GLA)

Appropriate Usage of Doxycycline
In systemic medicine, doxycycline is the one of the most used antibiotics on a long-term basis, but there may be instances where this oral medication is not ideal. Derek says the therapy is used aggressively with ocular surface diseases, and although there are some light side effects, it is one of the most tolerated medications for patients. Walt explains that while he uses doxycycline frequently for OSD, he avoids the medication for infectious conditions such as cellulitis.

http://eyetubeod.com/series/no-stand...f-doxycycline/
-----------------
Management of Inflammation From Dry Eye
Scott Hauswirth, OD, sits down with Drs. Leslie O’Dell and Whitney Hauser to discuss how he addresses inflammation in his clinic. Dr. Hauswirth explains his strategy for managing dry eye disease and preserving patients’ ocular surface and tear film. He also comments on new treatment options on the market as well as the role of ocular nutrition.

http://eyetubeod.com/series/she-said...-from-dry-eye/

[dryirisheyes]

Hi CharlieGreenEyes and MGD1707, many thanks for getting back to me.

I met my opthamlogist yesterday who exammined my glands. He said the glands on my top lid are functioning almost normally. The glands on my bottom lids however are the problem, he said none are functioning normally. He said the inner section are trickeling out a small portion of oil and the outer section are not really functioning. He has suggested probing as the next step. I am worried (like you CharlieGreenEyes) that some of my glands have died off - the opthamologist suspects so also as some of my openings are very thin. He said that I need to try and conserve what I have got left in terms of functioning glands and try and get the dysfunctional ones working to some level. He said the glands that are gone are more than likely gone for good. Failing the probing he said symptom management is the way forward. I guess from my side I never really expected a cure and deep down I probably know I will be dealing with this issue for the rest of my life in some shape or form. Even if I got 20-30% of my lower glands functioning I think it would make a difference to me.

The antibiotics definitely help my symptoms and inflammation but I am at the stage of life where I would like to start a family and I know pregnancy and doxy/tetracycline is a no go area.I am also on Ikervis and from reading the patient leaflet it too is unsuitable during pregnancy.

MGD1701 thank you for posting those videos - very informative.

Just wondering if either of you have had any experience with probing? I dont want to do any more damage and make my situation worse. I am considering getting a second opinion before going for probing just to put my mind at rest.

[MGD1701]

Hi Dryirisheyes

You wrote: ''my opthamlogist said the glands on my bottom lids however are the problem, he said none are functioning normally.
He said the inner section are trickeling out a small portion of oil and the outer section are not really functioning. He has suggested probing as the next step.''

Did your dr say WHY
the inner section are trickeling out a small portion of oil and the outer section are not really functioning?

Probing:
What I know from others in the forum is if one has scar tissue (cased by inflammation), probing helps.
My dr (a professor) said I did not have scar tissue and almost all doctors said I do not have inflammation/demodex but only with slit lamp.

Did dr make any recommendations to you?

Diet: all I have read is diet plays an important role in dry eye/inflammation. Maybe you can try to improve this, if you have not done so.

Good luck!

[CharlieGreenEyes]

Wishing you well with starting a family. Has your opthalmologist got any suggestions of a safe alternative to ikervis and doxy that you could take?

Agree with MGD1701 about diet helping - including Omega 3. I've heard fish oil Omega 3 is best, but I'm vegetarian so take flaxseeds instead. There are special Dry Eye Omega 3 supplements out there and I was recommended one by an opthalmologist but it was quite expensive so I don't use that for now.

I haven't tried probing. I wanted to look into it but wasn't sure if it was offered much in the UK (especially on the NHS but also privately). Are you in Ireland? I don't know about availability of treatments there so perhaps you can get it on the public healthcare system? I'd say it's worth trying probing - if it's likely to help you (obviously this is just my opinion based on my experiences and how desperate I am to get this condition under control, rather than medical knowledge).

I can't remember for sure but I think someone on here had probing first and then lipiflow once the probing had opened the glands - I think it was Hokucat (apologies if I've got this wrong). I often have to speed-read because my eyes can't cope with being online or reading for too long. Also sorry I can't find a link to the relevant thread (I'll come back again to do this if I can find it).

Another possible treatment to help. I know almost nothing about this so apologies for the lack of info about it, but my ophalmologist mentioned something called IPL. He told me it was something I could try if things didn't improve by the time I next saw him (which is soon).

[Hokucat]

Probing was necessary to unblock my glands first, because it turned out I had several glands with scar tissue, nothing else would have been able to unblock my glands. After probing, I made different changes to my diet until I found the fresh lemon juice in green tea was what my body needed to get my meibomian glands flowing and not get blocked up again, and also seemed to give me more tears. So it was a two step process, probing + diet changes, that worked for me, neither would have worked by itself.

I think it was Pythonidler who originally tried IPL and Lipiflow before probing, which did not work. He then did probing, which like me, may have unblocked scar tissue, and then did IPL again a few times and started seeing results, and continues IPL for maintenance.

So although probing is indeed more invasive than most other treatments, it may be one of the only treatments to unblock glands with scar tissue or other stubborn blockage first, so that other treatments, diet changes, medications, supplements, etc. that could not work before might help after probing.

[dryirisheyes]

Hi guys thank you for getting back to me. Its great to share experiences with others going through similar situations.

MG1701 he said that my oil glands are not functioning properly due to the oil being like toothpaste and chronic inflammation in my eye. I have been working on my diet of late and trying to eat unprocessed foods / reducing sugar etc. I have been taking a special omega 3 suppliment for dry eyes for the last few months which I think has helped a small bit. I am going to go for an allergy test next week to see if anything shows up.

CharlieGreenEyes I have not yet asked my opthamologist about an alternative to doxy/Ikervis but I will do this in my next follow up appointment. I totally sympathise with you ill try anything to impove my situation (so I will probably try the probing plus it is covered on my private health insurance). I am not sure if some of my glands are gone though - its a very scary thought being suck with these chronically dry and red eyes forever (I am having a bad eye day today). Before I go for the probing I am going to seek a second opinion just to put my mind at rest. I definitely feel that the antibiotics doxy and tetracycline have helped me but the opthamologist does not want to put me on these long term - even a low dose. So I am interested to get a second opinion on that.

Hokucat. Thank you for the response I am so glad you had success with the probing - there is light at the end of the tunnel. What are your glands functioning like now? did you have any atrophy or drop out? This is my concern at the moment - I have found one place in Ireland that offers a meibography - but I am almost afraid to go for it (before probing). Not sure I want to find out how much or how little gland functionality I have left!

[nori2015]

dryirisheyes im going to private message you

[dryirisheyes]

nori2015 thanks for the PM just responded there

[woodart]

I have been on doxy straight for about 5 years now. I take it with food in AM and at night I do a probiotic. So far I have tolerated it. With heat it seems to be staying decent. I am no expert and not crazy about taking it everyday but until we actually get a cure for it I will just have to deal with it. I do flaxseed oil which fortunate for me has been wonderful. I also do fish oil mostly just to make sure I of plenty of omega 3. When I started flaxseed the change came on quickly and was easily noticed in my eyes by the doc I had then. I am actually finally getting my insurance changed so I can afford to go back. The doc I have now is not bad but nowhere as good.

[dryirisheyes]

woodart many thanks for the post. sorry for the delay in getting back to you. Good to hear that you are tolerating doxy well. I take omega 3 and flaxseed capusles also - I think they help a little. I think a big consideration for me is that I would like to start a family soon and it is not possible to take an antibiotic like doxy while pregnant. I will also my opthamologist on my next appointment if there is any alternatives. I am on Ikervis also which seems to help.

[hannsho]

Hi Dryirisheyes,

There might be a solution with regard to antibiotics and your problem of MGD /ocular rosacea. This is, in fact, what I have been diagnosed with. The solution might be oral Doxycycline 40 mg. Note, that this is much lower than the normal dosage of 100 mg. The low dosage (40mg) means that it works on a sub-antimicrobial level and that therefore there is no danger of developing any bacterial resistance; it has virtually no side effect. It's value lies primarily in its potent anti-inflammatory action. It can be taken for long periods of time or even indefinitely. I have used it for 6 months with no problem whatsoever. Doxycycline 40 mg is often sold under the brand names 'Oracea' or Oraycea'. Since we have virtually the same eye problem, I might be able to make further suggestions if you find this treatment is not suitable for you. For the moment the link below is to a study that confirms the effectiveness and safety of Oraycea, but there are quite a view other clinical studies that basically say the same.

[hannsho]

Sorry, Dryirisheyes. The link above does not seem to work. So perhaps if you copy and paste the link below you get access to the PDF. Alternatively, you can google 'Treatment of ocular rosacea with 40 mg doxycycline in a slow release form'

http://mediskin.cn/uploadfiles/file/...91445_9439.pdf

[hannsho]

One more thought, Dryirisheyes


It is perfectly possible to use Ikervis (or any formulation of 0.05 cyclosporine) and doxycycline together on a long-term basis. That is provided the doxycycline is the slow-release 40 mg version that I mentioned earlier. I currently use cyclosporine 0.05, made up for me by a special pharmacy - which is a lot cheaper than Ikervis or Restasis - on an indefinite basis, prescribed to me by an ophthalmologist who is a specialist in surface ocular disease. Like you I have ocular rosacea, inflamed eyelids and toothpaste-like secretion form my oil glands. So I really sympathize with what you are going through and understand the desire to try anything to find a suction. Ocular rosacea is a chronic disease with frequent flare-ups that is basically not curable. The challenge I think is to find to find a way to manage it so that one can comfortably live with it. This is why it is good to exchange ideas and experiences in a forum like this. Perhaps a combination of Ikervis and 40mg slow-release doxycycline used simultaneously could work for you.