Running out of options -- Blepharitis/MGD

[redstudent898]

I'm not sure where else to turn, I discovered this forum after clicking on link after link searching for an answer to my problem. I don't know what the usual protocol here is but I'm going to give my history in hopes that someone has advice. Apologies if it's long winded.

I'm 21 years old and have never had an eye problem before other than being nearsighted. That changed about 4 months ago in early July when I woke up one morning with red eyes. There was no dryness, discomfort, discharge, itchiness, nothing--just bloodshot. I'd slept fine that night, I hadn't changed my routine in any way whatsoever, nothing had happened. I used some naphazoline eye drops and the redness went away. I now know the long term effects of vasoconstrictors, but depended on them until mid August. Throughout that time I experienced no symptoms but the redness, no dryness to speak of.

I finally saw an ophthalmologist who told me to discontinue use of the drops and said the redness is due to blepharitis. Again, there were no other symptoms but redness--so no scales/flakes, misdirected eyelashes, etc. The doctor didn't say, but I now suppose he meant posterior blepharitis which I believe is simply another name for meibomian gland dysfunction. He advised me the usual: scrubs, warm compresses, artificial tears. I did this from about August 20th to September 2nd with absolutely no change in redness, but I did begin to develop dryness. Summer was over and I headed back to school, the redness was the worst I had ever seen it and dryness had progressed to absolute agony. I was thankfully able to see an ophthalmologist the first day there. He too noted the blepharitis and prescribed me TobraDex (corticosteroid/antibiotic) as well as to continue warm compresses.

This was the first time I had felt any real relief, the TobraDex drops truly were magical for the time I was able to use them. My eyes were still as red as could be in the morning, but with the drops that was gone in an hour along with the dryness. Eventually I began to notice symptoms correlated with high intraocular eye pressure and became worried, so I returned to the doctor--this was last Thursday. My IOP had about tripled, so I had to immediately discontinue use of the magic drops. He then prescribed my doxycycline pills and erythromycin eye ointment. I've been taking those since Saturday with absolutely no change in symptoms. I've also been taking an omega-3 supplement for several weeks.

I went to another doctor today who said I don't have blepharitis, but that my oil glands don't seem to be producing much. I wasn't prescribed anything, but he said to use more artificial tears since I've stopped using those because they only offer relief for about 30 seconds (even the thick carboxymethylcellulose ones) and no redness relief at all. He also suggested I look into lacrimal plugs, which he couldn't offer since I'm going back to school on Sunday.

Here are the details in bullet points:

• Eyes most red in morning, but not at all dry
• Redness worsens at night again
• Redness persists whether eyes are dry or not, some days there is no dryness at all
• Redness becomes markedly worse during exercise, dryness becomes markedly better (how can MGD/dryness explain this)
• Might have blepharitis/MGD
• Currently taking doxycycline twice a day and using erythromycin ointment at night, also taking omega-3 supplement
• Doing warm compresses 4-6 times a day for minimum 8 minutes followed by massage and a scrub 4 of those times since Saturday, only warm compresses 2 times a day before that

At the risk of sounding melodramatic, this is ruining my life. My grades are suffering, my social life is deteriorating. Symptoms have only worsened with time and apparent treatment. It's my senior year of college and I would give anything to have my eyes return to appearing normal. Any help would be greatly appreciated, I'm at the end of my rope.

[Faith1989]

Hey. I will reply to this tomorrow or Saturday when I have more time. Just wanted you to know you are not alone I'll tell you what helped me- but there is no cure unless you find the cause-which is the battle!

Talk soon

[Guest]

Hi red student,

There's some things that you've asked which I cannot answer (they'll be someone here who can however!) but I'll just share what happened to me - hopefully it might help!

I had perfectly normal eyes like you until one morning they were inflamed, it came out of nowhere. It was mild blepharitis (I do believe that is probably what you have) but unfortunately I panicked and overused drops which, similar to vasoconstrictors, contained the preservative BAK which is damaging to eyes. When I was finally diagnosed with blepharitis a few months later I started a vigorous regime of compresses, scrubs and aritfical tears which, I eventually found out from my eye consultant, was irritating my eyes more and making them redder and redder.

Firstly go easy on the compresses and scrubs. I was overdoing it and making my eyes worse. Once or twice a day (morning and evening) should be enough for both. What are you scrubing your eyes with? I've discarded lid wipes as they too have a lot of chemicals - instead try a light tea tree wash or ocusoft foam and make sure you are gentle when using it.

I know it's hard but restrict yourself on artifical tears and make sure they are preservative free. hylo forte is a good brand.

About the eye ointment - I used a night one called vitapos for dry eye and for me at least, it was a big mistake. Lubricant with a greasy consistency can stop your own natural tears from working and keeping your eye moist. I found the ointment caused more red veins and was even questioning if it blocked my glands from working properly. Perhaps it's paranoia but for me ointment is a big no no.

Try seabuckthorne oil omega pills, they have helped me. Plus drink lots of water.

I know mentally how horrendous it is, my eyes are slowly getting better but god I was in a mess when this first started - my regime is now one warm compress every two days, light scrubs once a day and vitamins. My eyes are clearing up and I finally realised that all those drops, ointments, scrubs etc was making my eyes worse, the less tampering the better.

Although you are reliant on them now you can wean yourself down, I had punctual plugs in (lower) which keeps natural tears on the surface of your eye. I haven't used drops hardly at all since.

Claire

[redstudent898]

Claire, thanks for the reply.

From September to last Friday I was only doing warm compresses twice a day since that's all I could manage at school, it's only very recently I've started doing them more often as nothing changed. I'm using a Systane lid wipe, but honestly I don't have anything to really wipe on my eye lids. The last doctor I went to said they were perfectly clean and that I probably don't even need to do them.

I actually haven't been using artificial tears much because my eyes aren't dry that often, they're just red, very, very red. But the doctor I just saw recommended that I use them a little more often as a preventative measure as well as to fix an imbalance in my tears--I don't remember exactly what he said, but something along those lines. I did just buy some ridiculously expensive Freshkote eye drops after reading up on them, hopefully they're worth the price.

The ointment is prescription with an antibiotic, I don't know if it's had an adverse effect, but it definitely hasn't helped. Since it was prescribed I feel as though I should finish the tube... but maybe not, I'm not sure.

I'm taking Spring Valley fish oil, they haven't made a difference at all but the bottle was expensive and I don't have much money.

An update for today: My eyes are the reddest I've seen them waking up in the morning, maybe I should stop the erythromycin ointment. They also do feel dryer than normal. I have 3 days until I go back to school and right now I don't think I want to.

[Guest]

Claire, thanks for the reply.

From September to last Friday I was only doing warm compresses twice a day since that's all I could manage at school, it's only very recently I've started doing them more often as nothing changed. I'm using a Systane lid wipe, but honestly I don't have anything to really wipe on my eye lids. The last doctor I went to said they were perfectly clean and that I probably don't even need to do them.

I actually haven't been using artificial tears much because my eyes aren't dry that often, they're just red, very, very red. But the doctor I just saw recommended that I use them a little more often as a preventative measure as well as to fix an imbalance in my tears--I don't remember exactly what he said, but something along those lines. I did just buy some ridiculously expensive Freshkote eye drops after reading up on them, hopefully they're worth the price.

The ointment is prescription with an antibiotic, I don't know if it's had an adverse effect, but it definitely hasn't helped. Since it was prescribed I feel as though I should finish the tube... but maybe not, I'm not sure.

I'm taking Spring Valley fish oil, they haven't made a difference at all but the bottle was expensive and I don't have much money.

An update for today: My eyes are the reddest I've seen them waking up in the morning, maybe I should stop the erythromycin ointment. They also do feel dryer than normal. I have 3 days until I go back to school and right now I don't think I want to.

Fish oil normally takes a while to work, sometimes even a few months. Regular shop brand omega 3s do the same job - if you're short on money.

Blepharitis is all about maintenance, if that's what you definitely have, I just give my whole face a cold wash with tea tree wash as it's antibacterial and gently wash it over closed eyes. It's kept my blepharitis at bay.

Might be a suggestion to drop the ointment, you need to let your eyes breathe. Has it got worse since you started using it? Keep an eye diary documenting what you're doing every day so you can see when it gets more aggravated.

Could it be anything to do with allergies? Just looking at options here.

Ensure any drops you use are preservative free.

[redstudent898]

I'll sticking with the omega-3 supplement, I've read it does take a few months to make a difference.

I've had two doctors that told me I have blepharitis (they did not clarify what kind) and one that said I didn't. My eye lash area is perfectly clean, but the inside of the lids do look pretty inflamed and I can see lighter colored lined which I assume are the meibomian glands, maybe a picture would help.

I think I will stop the ointment, it stings a good amount until I fall asleep too. My eyes seemed to have gotten better this week until yesterday when I saw the doctor. Maybe it was all his probing, but that entire day they were extremely red and that seems to have continued today as well.

I've never had any kind of allergy and nothing changed in my environment. It also continued when I went to college in a different state, so I don't think its an allergy. Also, there's no itching or discomfort other than dryness which I think is usually associated with allergies.

EDIT: I attached pictures of my eyes and inner lower lids, the color isn't that true to life (much worse in person), but it gives an idea of what it looks like. Sorry, they're kind of huge.

[Guest]

If the ointment isn't working (and things have gone worse since using it...) stop. Try using a warm compress before you go to sleep and nothing else - see if that makes any difference.

Yep your gland area does look inflamed. The doctor prodding at it will cause irritation - mine were red after the consultant looked at my eyes. Be careful not to rub or touch your eyes - it'll make it worse.

To reduce the inflammation try cold compresses and preservative free artificial tears every so often stored in the fridge. Like I said try not to tamper with it too often.

[redstudent898]

I just tried a cold compress and it did seem to reduce inflammation which I'm glad about. However, it probably won't last long and I'm worried about its effect on meibomian gland function. If my MGD is caused by solidified oils within the glands, which the warm compresses are meant to liquefy, won't a cold compress only further exacerbate the problem? Also, would it work to put one of those microwavable warm compresses in the freezer to use as a cold compress?

I'm going to go to my ophthalmologist again hopefully soon. Although I'm not sure what else he can even do. If warm compresses and eyelid hygiene are not solving my problem, even with the aid of oral antibiotics and omega-3 supplementation, what's left? I will ask for punctual plugs, though.

[Guest]

I just tried a cold compress and it did seem to reduce inflammation which I'm glad about. However, it probably won't last long and I'm worried about its effect on meibomian gland function. If my MGD is caused by solidified oils within the glands, which the warm compresses are meant to liquefy, won't a cold compress only further exacerbate the problem? Also, would it work to put one of those microwavable warm compresses in the freezer to use as a cold compress?

I'm going to go to my ophthalmologist again hopefully soon. Although I'm not sure what else he can even do. If warm compresses and eyelid hygiene are not solving my problem, even with the aid of oral antibiotics and omega-3 supplementation, what's left? I will ask for punctual plugs, though.

Cold compresses shouldn't counteract anything - it's just to give your eyes from relief.

Punctual plugs would be an option further down the road - Opths won't resort to it right away. But that is an option if it doesn't get any better.

[Faith1989]

Have you tried steroids to get the initial inflammation down? I wouldn't get plugs until you have it under control. How's your diet?

[redstudent898]

I did, I was on TobraDex for a while and it worked wonderfully--no dryness or redness, but it turns out I'm a steroid responder so that's no longer an option for me.

Why do you suggest that about plugs? It was the optometrist I most recently saw who recommended them.

My diet isn't bad I don't think, at least not when at home, my mom is something of a health nut. My problem persists whether I'm at home or at school though, in fact it started at home.

[littlemermaid]

What is your computer-time like? Are you blinking enough to help your eyes heal while you're studying? Have you worn contact lenses for short-sight? Could oral meds or something recreational have triggered this?

Warm compress keep the glands moving, but cold compress reduces the inflammation if needed - even bag of frozen peas or keeping eyedrops in the fridge. Can't see how you could double-up your eyebag to do both http://www.dryeyezone.com/talk/showt...ght=#post93923

Eyelid margin cleaners keep the bugs away even if there is no obvious debris. Some people like OcuSoft, for example.

Have you never had chalazia?

Behind your eyelids does look cherry-red and sensitive right down to the bottom, left is worse - as ClaireW says, maybe to chemicals in eyedrops particularly, especially since you suffered after the Ophthalmologist exam - their examination drops are not preservative-free. With obstructed MGD from a skin condition, we get white colour right down at the bottom behind the eyelid so maybe that's why it looks like a sensitivity to me. Tobradex is not preservative-free, I don't think, so maybe even though it controlled inflammation it made the eye surface worse (we had the same with Maxitrol, red-sensitive again after a short while, especially without gentle compresses and lubrication). They should book an intraocular pressure check within maybe 10 days of starting dexamethosone.

Although the expense is difficult, it might be worth trying preservative-free lubricant drops until you find one that suits you because this is all about keeping the eye surface moist to enable healing, we've found, as well as keeping the glands good. We've done best on Hyloforte or similar.

If you want to try to examine meibom, press gently upwards with 2 fingers underneath your lower eyelash line and pinch gently. Meibomian gland outlets are the row of tiny dots along the eyelid margin between the eyelash bases and where the eyelid margin meets the eye surface.

Can you wait on punctal plugs until you see the Ophthalmologist? Ask the Ophth to check for incomplete blink, if they haven't already.

I would listen very carefully to ClaireW on all this, especially healing after the vasoconstrictor. Do you think computer goggles would help while you are studying? Many people here are wearing wraparound prescription sunglasses too, which can look pretty cool.

Putting your health first, gentle exercise and thinking positive gets us in the right frame of mind to work out what might be making things worse, and all factors that are useful and help, but if it's getting difficult at University, consider notifying a student counsellor what's happening. That's also useful if you need evidence for grades.

[redstudent898]

littlemermaid, thank you for your reply.

I am on the computer a lot, but have been long before this started. I do keep it in the back of my mind to blink often now though. I wear glasses, no contacts. The only medication I took was in early July when I had mono, the doctor put me on antibiotics before the diagnosis which I took for a few days. After that I was on acetaminophen-codeine pills for throat pain for maybe a week as well as a low dose of tramadol for maybe a month. I actually forgot about this. There was a gap between ending these medications and the start of red eyes though.

I just did another cold compress as I just exercised and my eyes were ridiculously red, it seems to have calmed it down. I got another bead eye cover thing today that I'll just keep in the freezer for when I need it, probably once in the morning because that's when this is worst and then once after I exercise, which I do daily.

I'll continue the eyelid margin wipes, probably when I shower in the morning. I have systane lid wipes.

I have never had a chalazia.

The inflammation is definitely worst on the outsides. Those pictures are kind to the actual redness, they were taken probably at the time when the inflammation is best and the color isn't exactly accurate. The doc did check pressure a week later, and I think it even went up but he didn't say anything. I took it upon myself to check again, glad I did.

I bought preservative free Refresh Advanced eye drops today to try to get that oil layer better. I'm going to limit myself to 4 a day max, maybe keep to 3. My eyes aren't dry too often. Is FreshKote not ideal either? I have those coming in the mail next week.

The optometrist I just saw did that with my eyelids to check, he said not very much oil is coming out.

I will ask the ophthalmologist I've been seeing near school about the incomplete blink, and what he thinks about plugs.

The optometrist said the adverse effects of the vasoconstrictor drops should be gone by now, I guess there's no way to be sure. What are these computer goggles?

I'm trying to be positive about this, but it's very difficult. This is a bad time for this to be happening to me.

To update how I'm doing today: My eyes were red as usual upon awakening and pretty much were throughout the day. Dryness was not at all a problem, at least I couldn't feel any. This is probably because I did a fair amount of exercise and I went to town. Usually when I'm outside I can't even tell that they're dry, same when I exercise--although that increases redness significantly. This includes either aerobic exercise or heavy lifting.

Another update: My eyes are not dry at all, but very, very red. The effects of that cold compress sure were short lived.

[Faith1989]

Sorry if you already said this but... Are you in pain or just the red eyes?! Just wondering!

[redstudent898]

The red eyes are constant, terrible in the morning (no pain whatsoever) bad throughout the day, terrible at night. The dryness I usually don't feel until I go to a dry classroom or its late at night. Right now, though, my eyes don't feel dry at all. Maybe it's the refresh drops, they were dry last night--but they are very, very red.