Steroid drops and BAK

[DryLondoner]

Has anyone come across any studies which discuss how BAK or steroid drops can exacerbate dry eye?

[spmcc]

Pubmed search here: http://www.ncbi.nlm.nih.gov/pubmed/

Here's a recent study: http://www.ncbi.nlm.nih.gov/pubmed/24931157

What would be good is to get your hands on all the references used in this paper.

[DryLondoner]

Thanks, spmcc.

[DryLondoner]

I thought I'd post an update for those browsing and wondering about how BAC/BAK and steroid drops and how they might make eyes worse. I have stopped using both for about 3 weeks now, and have seen/felt a huge difference already. They are by no means normal, but 3 weeks ago I couldn't leave my house without red veins developing in almost a flash and a horrible gritty feeling developing. I know everyone is very different, but after 6 months of using drops with preservatives and then about 2 weeks of steroids my eyes felt worse than ever. This morning I walked down a windy street and they were ok. I've just spent 2 hours on a computer (with breaks every 15 minutes) and still not too bad.

So if you are in a similar place don't give up - I took a week off work and just looked after them and myself and am now taking things slower and being kinder to my eyes and I can feel the difference.

[tealeaf]

DryLondoner,
I am using lotemax steroid drops currently (supposed to use for a month and stop) and indeed it makes my eyes drier. However, my eye specialist says it is supposed to kill inflammation and inflammation causes more dry eyes ... a chicken and egg thing. So far, lotemax is still bearable for me. The previous time, I was put on FML steroid drops and caused me so much panic.

I am still learning to take things slower. My job requires me to stare at the PC all the time. On occassion when my eyes feel drier, can't help to think how life was better back then... Well, got to stop thinking and talking about then.

Have you taken a plane since post lasik? Any issue with the dryness in the plane?

By the way, keepus posted about your next eye check up and wishing you all the very best in the shirmer's test

[DryLondoner]

Hi TeaLeaf,

I do believe so strongly that the body can (to some extent) heal itself, but we put so much stress on it - it's going to go wrong somewhere. And anxiousness causes dry eyes (I read somewhere on the internet) so no regrets.

Regarding steroids, I'm sure they do kill inflammation, my eyes look like new with them, but felt horrible, however everyone's different. And I don't really understand why they make our eyes dry...any ideas? My opth. says he wants me to try contacts and then steroids, I said I'd only do preservative free steroids but am so scared to put anything in my eye at the moment!

Flying - well I am supposed to be moving to KL (your neck of the woods) in 5 weeks - that's a 7 hour flight, 2 hour stop off, and another 7 hours flight. I am PETRIFIED! I flew two months post LASIK which is when this whole thing started. I am moving to KL for two years...scared that my eyes will hate the A/C, which I have heard is quite in fierce in many places. It's something I've been wanting to do for two years, so really don't want to back out either. Any advice?

Hope you're doing ok!! Thanks for the luck for my schirmer test! When I'm on the PC I close my eyes every 10 minutes lightly and focus on my breathing, I might look like a freak - but hey - I don't care anymore if it helps me heal!

[tealeaf]

Hi DryLondoner,
Yes, I also believe the body will heal itself too, but different body heals at different speed.

I have no idea too with regard to why steriods are causing dryness. FML made my eyes SO dry. Why did your opth. suggest on wearing contacts? Is it to prevent abrasion on the cornea?

Malaysia is a high humidity country, so when you are out on the street, your eyes should feel more comfortable. In office, as long as you don't sit where there is A/C draft, should be ok (or request to close/tape off one side of the aircon vent). If the draft is too strong, will be good to wear spectacles. I have a humidifier around for just in case.

Flight - Do you have moisture chamber spects with you? Think will be good to use on the plane. I am thinking to purchase 1 pair, but seems like there is none in Singapore. Don't really want to order on-line in case it doesn't fit.

By the way, are you doing warm compress and lidscrub?

[DryLondoner]

Hi TeaLeaf,

Hope you are doing ok. My opth. wants me to try contact lenses as he thinks my eyes are hypersensitive, he thinks the contacts will reduce sensitivity. I don't know how he formed this theory (other than me saying my eyes feel sensitive, and I can feel every small gust of wind). I will discuss what scientific evidence he has.

I am looking at buying moisture chamber glasses. You should be able to to return to most sites if they don't fit! Or buy some tight fitting wrap around glasses.

I don't do warm compress or lid scrub - my eyes get worse when I do this, as it increases inflammation, and I think my oil glands are ok (although I know these things are interconnected, so I'm watching them closely and having them checked at each visit). I also have a dustmite allergy, so get inflammation from that.

Oh, after a week of waking up with comfortable eyes, that were hardly red on waking, I've one back to square one. I see an acupuncturists who is great, but haven't seen him for two week as he is on holiday - I'm hoping this is the reason!!

[tealeaf]

Hi DryLondoner
I don't know if I am right, but it seems like people with dry eyes have hypersensitive eyes. I read in this forum people complained about menthol sensation when exposured to aircon or wind. I really cannot stand moving air; have to quickly close my eyes as they dry up my eyes real fast and will cause grittiness thereafter.

I went to see my opth. 2 days ago and checked with him if I have Blepharitis, he said a little thus recommended me to do warm compress and lid scrub. I am not sure if warm compress is helping as it always make my eyes feel stickier after that. When you say increase inflammation and eys get worse, do you mean your eyelids are painful or eyes turn red?

I hope you have comfortable eyes again! I can truly understand how you feel when you mean back to square one - as I battled with good and lousy eye days too.

[DryLondoner]

Hi Tealeaf,

I wonder if steriods/preservatives can cause eyes to become more sensitive as well as dry. My eyes have felt worse in the past two months, which doesn't make sense with LASIK. After the steriods they felt worse, and even on stopping the steriods (now off preservatives for 4/5 weeks) they still feel irratated. Something I need to research.

My glands look ok, I'm keeping a close eye on them as I know AD can impact the glands - I'm referring to red eyes when I say inflammation, I assuming the inflammation is causing redness...that may not be technically correct.

Hope you are having more good days than lousy ones!

[MGD1701]

Maybe someone are interested in this

Low-dose steroids lose efficacy in patients with concurrent dry eye and GVHD

Written By: Wuqaas M Munir MD
May 31 2018

This study compares the efficacy of topical steroids in patients with dry eye disease (DED) who do or do not have underlying graft-vs-host disease (GVHD).

Clinical significance
This study demonstrates that moderate DED secondary to GVHD does not respond as readily to low dose steroid therapy as non-GVHD associated dry eye. These findings suggest that either more aggressive steroid therapy may be needed, or alternatives to topical steroids should be considered in this more advanced group of dry eye patients.

Study design
This prospective, ad hoc analysis of a prior randomized trial examined 42 patients with moderate to severe DED, including 21 patients with chronic GVHD. All patients received loteprednol etabonate 0.5% ophthalmic suspension or artificial tears, twice daily. Patients underwent a masked ophthalmic evaluation prior to starting the regimen and were reevaluated 4 weeks after treatments.

Outcomes
The groups had similar signs and symptoms of DED at baseline. In the non-GVHD group, loteprednol use decreased the Ocular Surface Disease Index (OSDI) score by 34% (P=0.001) and the corneal fluorescein staining (CFS) score by 41% (P=0.016). Artificial tears decreased the CFS but did not alter any other parameters.
In the GVHD group, loteprednol decreased the Schirmer test scores (P=0.043) but did not affect OSDI or CFS scores (P=0.66 and 0.85, respectively). Artificial tears produced no significant changes in this group.

Limitations
This small study showed a trend toward greater use of autologous serum tears in the GVHD group at baseline than the non-GVHD group, though this trend was not statistically significant. The GVHD also had a higher OSDI score at baseline compared with the other group. The authors suggest this finding may indicate that the GVHD group included patients with more advanced illness at baseline compared with the non-GVHD group. Also, given the propensity for ocular GVHD to produce lacrimal gland fibrosis, it is possible that the lacrimal gland is no longer an effective target for steroids.


from https://www.aao.org/editors-choice/l...atients-with-c

[hannsho]

Hi DryLondoner

My experience has been that the use of eye drops with a combination of corticosteroid and BAK definitely make my eyes feel dryer. I used TobraDex eye drops, which contain a powerful corticosteroid (Dexamethasone 0.1%) and BAK 0.01 to control recurring redness of my left eye. The normal recommended dosage is to use one eye drop every 4-6 hrs for the first 48 hours and later perhaps only three drops a day for a week. I stared using Tobradex drops as soon as I noticed my eye going red, usually 4 times a day for a period of about 2 days. This would buy me 2-3 days of eyes without redness, after which I had to start using the drops again. However, I found that if I used 4 drops a day, my eye would become unbearably dry in the evening and that the most I could use were 3 eye drops per day.

My suspicion is that it is BAK and not the corticosteroid that makes eyes feel dryer.

[farmgirl]

[LEFT][COLOR=#252C2F][FONT=Helvetica][SIZE=16px]

My suspicion is that it is BAK and not the corticosteroid that makes eyes feel dryer.

I think the operative word is 'feel'