dry eyes treatment for Meibomian Gland dysfunction/Blepharitis

[ok45sg]

Hi,
See her severe dry eyes
https://www.dropbox.com/s/2pjtj0qfkq...ed%20.jpg?dl=0

I seek advice for my friend who is visually impaired and ignorant of treatments available.

I brought her to see the dry eye specialist for the first time after 3 weeks of inflammed eyes :
she was given following prescription for Meibomian gland dysfunction. :
eyelid wipes morn and night,
then warm compress on eyes 10 minutes morn and night
Eye drops :
1) every hour 1 preservative free Tears Naturale Free
2) every 3 hours, works out to 5 times a day : sterile, need refrigeration(kept only for 2 weeks tops) Acetylcysteine 5% eyedrop - costly at US80 a week.
3) vidisic gel - 3 times a day
Each of the diff eyedrops to have a 5 minute interval between them in the above order.
----
Now 3 weeks later after the visit, she can hardly open her eyes because it hurts. The ophthalmologist only wants to see her in 3 months' time as it is standard practice
for subsidised dry eye patients, implying patient can't go back to ask to be treated earlier.
---

Now that the visit is over, I wonder why didn't the doctor prescribe steroid Restasis to treat her badly inflamed eyes?
Or have they seen too many patients that they are insensitive to the pains of the patients since it is not life threatening?
---

This treatment that uses Acetylcysteine is expensive, so this senior citizen needs to keep her expenses down.
Would appreciate advice: how long does it take to know if the treatment is working?

Much thanks in advance, sufferers.

[meibomian]

This looks like a filamentary keratitis. Due to inflammatory process related to "dry eyes". Would make sure lacrimal ducts are patent (obstruction very common in elderly) and short course of topical steroids would be helpful. Do warm compresses and keep eyes lubricated, without using ointment. Can try acetylcysteine if other measures fail. What lid wipe is being used. Feel free to PM me for more details.

[ok45sg]

TLC eyecare wipes- cloth in convenience pack.

I forgot to mention that she is on omega 3, 1000mg - 3 capsules a day. She gets Link from New Zealand - Omega 3 salmon fish oil /Kordel HI Omega 3 wild salmon and fish oil 180epa and 120mg DHA in both of these.

I pm you meibomian.

Thanks a lot.

[ok45sg]

Update to dry eye treatment :

Didn't mean to hop around but after a month with no improvement, we had to seek 2nd opinion. Next eye doctor suspected it could be allergic reaction as the patient's eyes are not dry under the scope. But said that it's of no use to test for skin allergy as there are a thousand and one causes and it would worry the patient. Any opinion on that?

This ophthalmologist cleaned up the eyeballs which provided temporary relief. Question: Can we clean up our eyeballs with cotton buds ourselves at home after applying 0.5%alcaine(Propraracane Hydrochloride) as was done at the clinic?

Treatment:
1) vidisic gel - morn and night
2) 0.5% Alcaine whenever pain, Alcaine drops are a topical local anesthetic. It works on the nerves to decrease pain.ALCAINE Eye Drops contain 5 mg/mL proxymetacaine hydrochloride, together with glycerol, hydrochloric acid and/or sodium hydroxide (to adjust pH) and purified water. The solution is preserved with benzalkonium chloride (0.1 mg/mL). Oh no,it contains BAK which on dryeyezone we have been warned against as possibly inducing ocular surface damage.

3) Steroid Anti-infectives Dacle eyedrops containing composition: Each ml contains - Chloramphericol 5mg(potency), Tetrahydrozoline Hydrochloride 0.25mg, Preservative Methyl Parahydroxybenzoate 0.4mg, Prepyl parahydroxybenzoate 0.1mg. For a week. Clinic warn against possible side effect of inducing glaucoma but a short course of the eyedrops is safe.
Is this Restasis equivalent(cyclosporine ophthalmic emulsion) 0.05%.?

4) Patanol containing olopatadine(HCI) 0.1% composition: 1.1mg olopatadine hydrochloride equivalent to 1 mg olopatadine. Preservative: Benzalkonium chloride 0.01% - oh no, again BAK. , and other inactives - for allergive conjuctivitis.

Ophthalmologist said nothing much can be done about the inflammation but to use Alcaine and Patanol from henceforth to relieve the inflammation.
MGD/Bhepharitis are merely symptoms, not the cause.

Can you give your informed opinion on the queries I had re treatment version 2?

Your attention is deeply appreciated, fellow sufferers.

[KarenRB53]

This looks like a filamentary keratitis. Due to inflammatory process related to "dry eyes". Would make sure lacrimal ducts are patent (obstruction very common in elderly) and short course of topical steroids would be helpful. Do warm compresses and keep eyes lubricated, without using ointment. Can try acetylcysteine if other measures fail. What lid wipe is being used. Feel free to PM me for more details.

I've been told to use Cliradex eyelid wipes which contain tea tree oil. Have not helped at all and sting terribly. Can you suggest a lid wipe? Opthamologist said I have blepharities, MGD and ocular rosacea. Its mostly the terrible yellow crusting on eyelids in morning and white stringy mucous that hinders my eyesight that is most bothersome. Also, afraid my eyes will keep getting worse. Thanks for any suggestions. Karen

[ok45sg]

Hi Karen,
Sorry to hear about this. I have been told by an ophthalmologist that eyelid wipes done wrongly come with a risk getting eye infection. You will have to buy and test the eyelid wipe to try them .

Eyelid hygiene products

1) foam eyelid wash out of a can - applying foamy suds on clean fingers to rub the eyes(as per instructions on bottle),
2) tiny eyelid tissue wipes which usually I will tear into half to use frugally,
3) blephagel gel preservative free on cotton ball (cheapest option).

Best.

[ok45sg]

Currently, using TLC brand of Eyelid hygiene product, cheapest : http://www.ebay.com.sg/itm/TLC-Indiv...-/191681244396

Update of dry eye syndrome treatment in Singapore:
Patient tried Chinese Traditional Chinese Medicine, was effective 5 years ago (age 65 then) till recently.
Now patient willing to try more aggressive western treatment.
Going for Another eye doctor:
Why? Because the previous eye doctor says no other treatment except to apply eyedrops to relieve symptoms.
But on dryeyezone here, I know there are other options such as punctual plugs, Restasis to try.
Hence the next eye doctor:

Oral nutrition(complete):
Omega 3, 1000 mg, Link from New Zealand- Salmon fish oil Omega 3 (but read a research online that New Zealand ones are dodgy: http://www.nzherald.co.nz/nz/news/ar...ectid=11389935) - sigh.
Chia seed drink
Omega 369 bottle of oil - 1 tablespoon a day (has flaxseed oil a few percentage), Malaysia blend of oils including perilla, sesame, etc.
Goji, Goji leaves soup - Goji=wolfberry
Boiled wild chrysanthemum water

Chinese Physician also recommended washing eyes in wild chrysanthemum water.

25/3 Private eye Clinic - suspected allergic reaction, hence Patanol. (as above thread - treatment)
but 3 weeks later, eye inflammation again in April.
Then took another round of Steroid Anti-infectives Dacle eyedrops containing composition: Each ml contains - Chloramphericol 5mg(potency), Tetrahydrozoline Hydrochloride 0.25mg, Preservative Methyl Parahydroxybenzoate 0.4mg, Prepyl parahydroxybenzoate 0.1mg. For 4 days.
Was okay.

Then 4th May, again inflammation.

Hence another private eye doctor (Government subsidised doctor's appointment only in June - Singapore medical system).

Treatment for 2 weeks :
Minim Dexamethasone steroid - 1 drop 3 times daily to reduce inflammation
Doxymcycin capsule antibiotics
Fucithalmic antibiotics - 3 times daily
Restasis - 3 times daily - 5 min gap in between is really enough
Vididic gel (last to apply as it is ointment) - 3 times days 5

And so it goes.

[ok45sg]

Addendum:
Acetylcysteine 5% eyedrop was supposed to be in there too as part of the treatment but patient baulked from the expense.
Doxymycyin capsule antibiotics twice a day after food. a

Previous prescription by previous eye doctor : not using.
Patanol which has BAK - not using.
Alcaine - although anesthetic - I don't think it should be for long term use.

Patient has filamentary kerastatis, Blepharitis = MGD

Symptom: eye pain both eyes, tearing, regular yellow strips of eye mucus, sometimes swelled eye bags.

[ok45sg]

Sorry, I missed out - the treatment does include:
action of : warm compress and eye lid hygiene - morn and night.