Doxycycline - how long does it take to start working?

[Alix]

I looked in the mirror this evening, and for the first time in over 10 months, the sclera of my eyes are milky white. Usually they are red or dark pink, at best light pink.
My eyes are still burning (albeit less so than usual) so this is nothing to get excited about, but I was thinking what have I done differently.

I am at the end of my course of steroid eye drops (put in one drop a day in the morning), and started taking doxycycline 2 weeks ago.

My questions are;-
1. Is it possible that steroid eye drops suddenly start working ie. reduce inflammation, in the 4th week?
2. Does doxycycline take effect as soon as 2 weeks? I was told it would take months and even then it's not a cure...

[deep_dry_eye]

I looked in the mirror this evening, and for the first time in over 10 months, the sclera of my eyes are milky white. Usually they are red or dark pink, at best light pink.
My eyes are still burning (albeit less so than usual) so this is nothing to get excited about, but I was thinking what have I done differently.

I am at the end of my course of steroid eye drops (put in one drop a day in the morning), and started taking doxycycline 2 weeks ago.

My questions are;-
1. Is it possible that steroid eye drops suddenly start working ie. reduce inflammation, in the 4th week?
2. Does doxycycline take effect as soon as 2 weeks? I was told it would take months and even then it's not a cure...

Doxy can definitely help in the 2 wk mark. Unfortunately, most patients return to baseline after doxy is stopped. But it's a good mechanism to clear the obstructions in the glands and have good secretions for awhile at least.

Since you are effective w/ doxy, this is probably an inflammation problem. You might want to give IPL, Xiidra and Restasis (all 3) a try. All 3 can help reduce inflammation and give better oil secretions.

[Alix]

Hi I don't want to use doxy long term but at the same time I am afraid that if it does work and then I stop taking it, I will go back to square one.

I want to try IPL but it is too expensive here in the UK and it is not covered by my private medical insurance. I do not have £1,200 to spare.

Xiidra is not available here, I'm not sure about Restasis, but in any case I am planning to start using Ikervis as soon as possible.

[Guest]

After 1 month on doxy, 100mg twice a day, my inflammadry test was negative for MMP9 in both eyes. It works pretty fast.

This is a loading phase, I will taper to 100mg a day and then 50mg a day and then stay on that pretty much indefinitely. An anti inflammatory dose of doxy can be as low as 25mg. It is also the only drug that can really attack the disease from the inside out.

im not excited about staying on an antibiotic the rest of my life, you know what’s less exciting than that? Burning eyes. So I’ll taje the doxy.

[Alix]

I see, I am only on 100mg once a day, which I believe is the standard dose.

How long did you take 100mg twice daily for?

[deep_dry_eye]

For reference, my Doxy dose is 40mg per day (once a day). This is the same dose use for most common acne cases.

[Guest]

I see, I am only on 100mg once a day, which I believe is the standard dose.

How long did you take 100mg twice daily for?

200mg for 60 days, then 100mg for 30 days, then 50mg Indefinitely.

[Alix]

I see this is useful information, thank you. I will carry on taking the doxy to see if there is any improvement, my eyes are burning quite badly today.
I long for the days when my eyes were normal.

[Guest]

Just so you know, I’m also on a few other medications and treatments which are really helping.

Autologous serum tears - I’m not sure if you have any ocular surface abnormalities, or if you would qualify for serum. But this has made my eyes so much more comfortable.

Preservative free steroids (methylprednisolone 1%) - I’ll be taking this for 6 months, I’m 3 months into the treatment, so I have 3 months left. My problem is that I sleep with my eyes open. We’re hoping that since I’m taping my eyes at night, once we get my eyes functioning better, I’ll be able to come off and maintain a decent state of function. hopefully!

Hot compress 2x a day - when my oil was like candle wax or butter, I had to heat my mask up to 45C and I checked it with a laser thermometer. It’s the only way I would avoid overheating my eyelids. Too much heat will make you feel worse, too little and the oil won’t melt. Now that my oils are clear, my compress is only geared to 40C. If I go any hotter, I end up with painful dryness now. So your regimen needs to constantly adjust as your body responds to treatment.

cold compress - when my eyes are burning bad, I can now use a cold compress, from the refrigerator not the freezer. At my worst, I couldn’t use a cold compress. Made my eyes worse. Now that the oils thin, it’s very soothing and takes that pinching, biting, burning pain away.

moisture chamber glasses - this has been one of the best things I’ve done for my eyes. I use less drops, my eyes burn less, I blink less...I am kicking myself for not buying them sooner. I have the Ziena and the 7eye glasses, they help so much and are also the cheapest thing I’ve done for my eyes. Almost forgot to mention these.

Hope me this helps.

[Alix]

Thank you I am yet to use cold compress, I'm willing to give it a try, although I have a feeling it is only going to provide momentary relief like everything else.

The serum tears are not an option for me as they are not readily available in the UK.

Are you using Xiidra/Restasis?

[Guest]

Thank you I am yet to use cold compress, I'm willing to give it a try, although I have a feeling it is only going to provide momentary relief like everything else.

The serum tears are not an option for me as they are not readily available in the UK.

Are you using Xiidra/Restasis?

No, I took restasis for 6 months and my Schirmer test wes 2mm and 3mm in right and left eye. The doctor said, stop restasis, it isn’t working. So once I stppped, I realized I was alllergic to it. It was making my eyes itch and eyelids burn and itch. So once I stopped, I got wayyyy better. Xiidra I used one time in my left eye, as soon as it hit my eye, I bent over in severe pain and grabbed my eye. I immediately flushed my eye with saline and never used it again. I will never use it again.

[mbperso]

I had doxy 100mg: one month out of 2. I got relief after 10 days

[MGD1701]

if stop doxy then the problem appears, so should we just automatically take doxy every 3 or 5 months (?) and for say 4 weeks? forever? or short-course of (low-dose) steriod is safer? What are recommendations from your doctors or experience?

Z-pak / Zithromax
I have heard this works faster or even safer for a long term?
Anyone try? comments? Thanks.

[deep_dry_eye]

if stop doxy then the problem appears, so should we just automatically take doxy every 3 or 5 months (?) and for say 4 weeks? forever? What are recommendations from your doctors?

Z-pak / Zithromax
I have heard this works faster or even safer for long term?
Anyone try? comments? Thanks.

Azithromycin (also branded as Zithromax), is a much better and faster acting medication than Doxy for MGD. There has been very studies out there that claim Azithromycin can change your gland secretions and is much more effective than Doxy. The reason its less popular than Doxy is that Doxy comes in 40mg dose forms (i.e., this is for sub-antibiotic dosages). Azithromycin doesn't come in such micro-dosages readily. Also, Azithromycin is the more potent antibiotic of the two due to recent antibiotic resistance (i.e., Doxy has been here much longer; and due to evolution of antibiotic resistance, it has lost its potency). Some doctors are more hesitant to prescribe Azithromycin due to the fear that bacteria may develop resistance just like Doxy.

IMO, Azithromycin is a very good drug for MGD and should be prescribed more often. Long term oral systemic Azithromycin might be questionable due to fear of resistance and no micro-dosages available, but there are many ophthalmic forms of Azithromycin. There has been various studies of oral systemic Azithromycin for severe acne patients, and the results are quite good, especially for patients who don't respond to Doxy.

Azyter is topical ophthalmic Azithromycin for available in the EU, is preservative free. Azyter is targeted to come to Canada in 2019. The US has AzaSite, which is also very effective and commonly prescribed for MGD as well, however, unfortunately AzaSite has BAK. Ask your doctor about these options.

[MGD1701]

Thanks a lot deep_dry_eye

how about short-course of (low-dose) steriod
safer than doxy/Azithromycin? What are recommendations from your doctors or experience?

then perhaps a combination of steriod, doxy/Azithromycin, Azyter, omega 3, GLA. something missing?