Treating ocular rosacea with Ivermectin (Soolantra)

[insidious988]

Just wanted to share this study made by Dr. Schaller from Tuebingen, Germany for you.


Sounds promising doesn't it? I hope Dr Schaller is ok with me posting this PDF, he kindly send it to me per email when I wrote about Soolantra with him. he is a known doctor from Germany reseraching in rosacea.

Problem is, I got prescribed Soolantra by an eye clinic since the beggining of may and I apply it every evening to the eyelid margings but no effect as of yet. Dr. Schaller says it can take up to 6 months so. So I will continue...

[insidious988]

also see:

[deep_dry_eye]

https://www.drugs.com/monograph/ivermectin.html
Ocular Effects

Ocular reactions (e.g., abnormal sensation in the eyes, eyelid edema, anterior uveitis, conjunctivitis, limbitis, keratitis, chorioretinitis or choroiditis) may occur in patients being treated for onchocerciasis or may occur secondary to the disease itself.¹

Do you have access to more traditional drugs such as Restasis/Xiidra or Doxy/Azithromycin? Feels these drugs are safer.

[insidious988]

Doxy: already on it since 9 months! (Oraycea 40 mg) I feel that it doesn't do much

ikervis: on it since march. Doesn't do anything as of now. I even feel that it worsens my condition but hard to be sure.

nothing helps. Nothing.

azythromicin I have at home now and will try after the steroid course

No Access to xiidra here sadly

Dr Schaller says topical ivermectin is safe and no side effects. Apply to eye lid margins and not into eyes. Kills demodex and acts antiinflammatory

But like I said nothing works as of yet with me

[optimusdryeyes]

Hi insidious988,
I also have ocular rosacea and trying to figure out what works yet. Mine was pretty manageable with eye drops for 4 years, but for the last month and a half, nothing seems to work just like your case. The weird thing is that I barely have the face type of the disease. I went to the Berkeley dry eye center last Monday, and the doctor said my eyelids are severely inflamed. She ordered Blephamide for 4 weeks to reduce the inflammation. Blephamide is a steroid and it acts as both an antibiotic to heal the cornea, and as an anti inflammatory to reduce the inflammation, but you can only take it for a short time, because long term steroid eye drops can cause glaucoma.

She recommended to cut down on heat compresses because heat is a trigger for rosacea and adds to the inflammation, so you might want to ask your doctor about cold compresses in place of or in conjunction with warm compresses. Computers are really harsh on dry eyes, so you might want to take frequent brakes and make sure you blink a lot. I am considering trying the japanese wink glasses https://www.japantrendshop.com/masun...es-p-1892.html which fog if you don't blink for few seconds, so that it keeps reminding you of blinking.

Finally, as a last resort, have you tried IPL for eyes? I have read mixed results about it. Some people report significant improvements whereas others not so much. I am leaving it as a last resort, because here in the US, it is very expensive and it is not covered by the insurance. The thieves say they won't cover it because it is used for cosmetic reasons, but in our case it is used for medical reasons. I really feel your struggle. This disease is a disease from hell.

[deep_dry_eye]

Hi insidious988,
I also have ocular rosacea and trying to figure out what works yet. Mine was pretty manageable with eye drops for 4 years, but for the last month and a half, nothing seems to work just like your case. The weird thing is that I barely have the face type of the disease. I went to the Berkeley dry eye center last Monday, and the doctor said my eyelids are severely inflamed. She ordered Blephamide for 4 weeks to reduce the inflammation. Blephamide is a steroid and it acts as both an antibiotic to heal the cornea, and as an anti inflammatory to reduce the inflammation, but you can only take it for a short time, because long term steroid eye drops can cause glaucoma.

She recommended to cut down on heat compresses because heat is a trigger for rosacea and adds to the inflammation, so you might want to ask your doctor about cold compresses in place of or in conjunction with warm compresses. Computers are really harsh on dry eyes, so you might want to take frequent brakes and make sure you blink a lot. I am considering trying the japanese wink glasses https://www.japantrendshop.com/masun...es-p-1892.html which fog if you don't blink for few seconds, so that it keeps reminding you of blinking.

Finally, as a last resort, have you tried IPL for eyes? I have read mixed results about it. Some people report significant improvements whereas others not so much. I am leaving it as a last resort, because here in the US, it is very expensive and it is not covered by the insurance. The thieves say they won't cover it because it is used for cosmetic reasons, but in our case it is used for medical reasons. I really feel your struggle. This disease is a disease from hell.

I encourage you to try IPL, follow this twitter feed of a MD dry eye expert: https://twitter.com/Dryeyemaster

[insidious988]

Hi insidious988,
I also have ocular rosacea and trying to figure out what works yet. Mine was pretty manageable with eye drops for 4 years, but for the last month and a half, nothing seems to work just like your case. The weird thing is that I barely have the face type of the disease. I went to the Berkeley dry eye center last Monday, and the doctor said my eyelids are severely inflamed. She ordered Blephamide for 4 weeks to reduce the inflammation. Blephamide is a steroid and it acts as both an antibiotic to heal the cornea, and as an anti inflammatory to reduce the inflammation, but you can only take it for a short time, because long term steroid eye drops can cause glaucoma.

She recommended to cut down on heat compresses because heat is a trigger for rosacea and adds to the inflammation, so you might want to ask your doctor about cold compresses in place of or in conjunction with warm compresses. Computers are really harsh on dry eyes, so you might want to take frequent brakes and make sure you blink a lot. I am considering trying the japanese wink glasses https://www.japantrendshop.com/masun...es-p-1892.html which fog if you don't blink for few seconds, so that it keeps reminding you of blinking.

Finally, as a last resort, have you tried IPL for eyes? I have read mixed results about it. Some people report significant improvements whereas others not so much. I am leaving it as a last resort, because here in the US, it is very expensive and it is not covered by the insurance. The thieves say they won't cover it because it is used for cosmetic reasons, but in our case it is used for medical reasons. I really feel your struggle. This disease is a disease from hell.

Thanks for the reply. I can see myself in many things that you wrote.
In my case the severe case are also the eyes, not so much the face. The face I can keep pretty much under control with lotions like metronidazol, Skinoren or now Soolantra. Slightly reddish and every few days a few pustles but nothing out of control.

But the eyes... it started 2011 with me and like in your case it was managable for all these years with eye drops. Since mid 2017 though, after I got another chalazion in the eyelids, it went downhill from there. Eye drops don't work anymore (no relieve at all and I've tried them all), Restasis doesn't seem to work or make it worse, even Steroids don't do nothing as of now, doxy doesn't help either. I am desperate. When I say the eyes burn all day I mean it literally. It drains the life out of me but I am still going to work as of yet.

I also do warm compresses 2x daily with the blephasteam. I do have a feeling though that it is indeed not good for Inflammation. What exactly did your doctor recommend? Cold compresses only or maybe daily cold compresses and 1-2/week warm compresses to get the oil flowing? What can I use for cold compresses and how often should they be done?

Next step is IPL, yes. Here in Germany the insurance won't cover it too, like in your case. But I don't know what to do anymore, so...
They say you do 3-4 sessions and each session is about 250 € here, so all in all I will be paying 1.000 €.
Maybe it works, maybe it doesn't. But if it doesn't, I don't know what other otions I have.

[optimusdryeyes]

Thanks for the reply. I can see myself in many things that you wrote.
In my case the severe case are also the eyes, not so much the face. The face I can keep pretty much under control with lotions like metronidazol, Skinoren or now Soolantra. Slightly reddish and every few days a few pustles but nothing out of control.

But the eyes... it started 2011 with me and like in your case it was managable for all these years with eye drops. Since mid 2017 though, after I got another chalazion in the eyelids, it went downhill from there. Eye drops don't work anymore (no relieve at all and I've tried them all), Restasis doesn't seem to work or make it worse, even Steroids don't do nothing as of now, doxy doesn't help either. I am desperate. When I say the eyes burn all day I mean it literally. It drains the life out of me but I am still going to work as of yet.

I also do warm compresses 2x daily with the blephasteam. I do have a feeling though that it is indeed not good for Inflammation. What exactly did your doctor recommend? Cold compresses only or maybe daily cold compresses and 1-2/week warm compresses to get the oil flowing? What can I use for cold compresses and how often should they be done?

Next step is IPL, yes. Here in Germany the insurance won't cover it too, like in your case. But I don't know what to do anymore, so...
They say you do 3-4 sessions and each session is about 250 € here, so all in all I will be paying 1.000 €.
Maybe it works, maybe it doesn't. But if it doesn't, I don't know what other otions I have.

For the warm compress, I used to do it two times a day for 20 minutes each, so she told me to do one time before bedtime with lid massages to get the oil flowing like you mentioned, and for the cold compresses just take a cloth and rinse it with cold water and place it on your eyelids few times a day. The idea is that warm compresses are great for the blepharitis of the eye lids, but ocular rosacea is inflammatory in nature so too much heat makes things worse. You have to strike a balance between oil flowing and not aggravating it. Also one interesting thing she told me and I am trying out right now is to not use ointment for nighttime. I used to use Retaine PM and she claims it might be making it worse. Her reasoning is that you are trying to get rid of the oils, and you are just adding more oils that are blocking the glands further. I do get my worst symptoms when I wake up. It doesn't get much better during the day, but morning is by far my worst time.

[insidious988]

For the warm compress, I used to do it two times a day for 20 minutes each, so she told me to do one time before bedtime with lid massages to get the oil flowing like you mentioned, and for the cold compresses just take a cloth and rinse it with cold water and place it on your eyelids few times a day. The idea is that warm compresses are great for the blepharitis of the eye lids, but ocular rosacea is inflammatory in nature so too much heat makes things worse. You have to strike a balance between oil flowing and not aggravating it. Also one interesting thing she told me and I am trying out right now is to not use ointment for nighttime. I used to use Retaine PM and she claims it might be making it worse. Her reasoning is that you are trying to get rid of the oils, and you are just adding more oils that are blocking the glands further. I do get my worst symptoms when I wake up. It doesn't get much better during the day, but morning is by far my worst time.

Thank you! This sounds really good, I will try it. I just ordered a mask for doing the cold compresses, it is called here in Germany "Thera Pearl mask" ( https://www.amazon.de/Thera-Pearl-TP...ds=thera+pearl ) . Doesn't cost much but should do the job. I already used this mask for warm compresses once but it got too hot in the microwave so I switched to the blephasteam. But for using it as cold compresses should be good out of the refrigerator.

So I will do a cold compress in the morning with the mask and during the day at work maybe like you said with a cloth.
I will do a warm compress in the evening only then.
Do you think massage after the warm compress is good? I recently saw a Video from doctor Korb and he said massage is not good and damages the cornea so I don't know if we should continue with that.

Ointment at night I feel is really not good. Thing is, I haven't found an ointment yet which I can tolerate. With every single ointment I wokue up with red and painful eyes. I don't know why. Maybe because what your doctor told you.

I also am worst at morning though, even without ointment...

[insidious988]

Can I ask what other things you do? As we seem to pretty much have the same disease.
What drops do you use during the day? I ordered Retaine MGD (here in Europe it is called Cationorm) again. I had them once already but they didn't work. Will try it again as doctors say they are the best with rosacea. I don't know, actually no drops work with me at all anymore.

[optimusdryeyes]

Can I ask what other things you do? As we seem to pretty much have the same disease.
What drops do you use during the day? I ordered Retaine MGD (here in Europe it is called Cationorm) again. I had them once already but they didn't work. Will try it again as doctors say they are the best with rosacea. I don't know, actually no drops work with me at all anymore.

I use Retaine MGD, and that was my goto drop for 4 years. I used to only need one vial for 2 days, but these days they just stopped working just like in your case. Right now I am in the process of trying many different options, like Oasis tears, Refresh Mega 3, and various others but so far I have not found the drop that gives me relief.

[bobXfr]

insidious988 thx for sharing the study.hope, they'll find the path way