Doxy for MGD

Very well said..... Couldn't have agreed more on that...ROFL

I am visit my opthalmologist for the second time in three days from today after roughly 4.5 months. Any advice?

I guess they might suggest a lipiflow or IPL but my problem isn't lipids solidifying. Rather the epithelial cappings over my gland openings. Haven't done a lipiview or a lipiscan yet. I am already feeling nervous thinking about the outcome of this consultation.Will be visiting the eye hospital travelling 1959 kms from my location and travelling back the distance. Expecting something more fruitful this time. Pretty sure that the doctor would be shocked to learn I am taping my eyes without her advice lol.

Man I’m not sure what advice to give. I just got my pressure checked today it was a tad bit high. I would say put together a list of questions so you dont forget. If you feel this dr isn’t answering your question with confidence, you may have to see another doctor. I guess my best advice is find a good doctor. If she’s not the one, move on. Because I wasted way too much time at the wrong doctors getting no help. I couldn’t gage done this myself. So he key is finding someone that can think out of the basic MGD box. There are A LOT of reasons the kids could be malfunctioning, getting someone to find the root cause is the hard part.

Get all all the testing you can. Good luck with the Lipiview. Sorry for the delay.

[Milo007]

I would love learning about dry eye more if I weren’t actually suffering from it lol.

Very well said..... Couldn't have agreed more on that...ROFL

I am visit my opthalmologist for the second time in three days from today after roughly 4.5 months. Any advice?

I guess they might suggest a lipiflow or IPL but my problem isn't lipids solidifying. Rather the epithelial cappings over my gland openings. Haven't done a lipiview or a lipiscan yet. I am already feeling nervous thinking about the outcome of this consultation.Will be visiting the eye hospital travelling 1959 kms from my location and travelling back the distance. Expecting something more fruitful this time. Pretty sure that the doctor would be shocked to learn I am taping my eyes without her advice lol.

Good thing is that you pursued what you wanted to do. At the end of the day it matters if you become what you always wanted to be. You loved college because you loved learning things. You had interests in multiple subjects because you have an inherent quest for learning irrespective of its direct relevance to you. Most people I have come across study something because they want something out of it or take it as a profession. I have seldom met people who are interested in learning something only to gain knowledge and quench their inquisitiveness.

But who knows! Maybe you could have been a world famous opthalmologist (dry eye specialist) had you pursued your studies in biology and took it as a profession!!!

We could have benefitted out of it lol.

Thank you and I cannot agree more about people drive for education. Most people are there just to pass the class. I didn’t care what my grades were, as long as I understood the information.

Ill never forget when this hit me. I was in molecular biology and we just went over a test we took. The final question was rejetively hard. She asked, if you have a patient with copd receiving oxygen and you increase the concentration, what happens to the patient? Long story short, they stop breathing by the way, so super important to know that lol.

I asked the the girl who set the curve in the class, what did you answer for that question. She said to me, dude, after I passed that test, I forgot everything I studied. This was the person who got the highest grade in the class. I got a C+ on that test but I realize I understood the information better than the person with the A+. Shocking revelation. I genuinely love learning. I would love learning about dry eye more if I weren’t actually suffering from it lol.

[Milo007]

My parents wanted the same, for me to be a doctor or a lawyer. Ended up working for our family business and going to college for 7 years for fun. Ended up with 270+ credit hours of business, biology, chemistry and philosophy. I loved college, was one of the best times of my life.

Good thing is that you pursued what you wanted to do. At the end of the day it matters if you become what you always wanted to be. You loved college because you loved learning things. You had interests in multiple subjects because you have an inherent quest for learning irrespective of its direct relevance to you. Most people I have come across study something because they want something out of it or take it as a profession. I have seldom met people who are interested in learning something only to gain knowledge and quench their inquisitiveness.

But who knows! Maybe you could have been a world famous opthalmologist (dry eye specialist) had you pursued your studies in biology and took it as a profession!!!

We could have benefitted out of it lol.

I was good in biology in high school and my parents wanted me to be a doctor. I ended up being a mechanical engineer... LOL

My parents wanted the same, for me to be a doctor or a lawyer. Ended up working for our family business and going to college for 7 years for fun. Ended up with 270+ credit hours of business, biology, chemistry and philosophy. I loved college, was one of the best times of my life.

[Milo007]

No clue on the emojis, but appreciate your insight. Hard to find people with a solid understanding of biology.

I was good in biology in high school and my parents wanted me to be a doctor. I ended up being a mechanical engineer... LOL

You are welcome!

Any idea why smileys don't work in this platform?

No clue on the emojis, but appreciate your insight. Hard to find people with a solid understanding of biology.

[Milo007]

Thank you for writing this, couldn’t agree more. Well said. I didn’t understand that difference between the two drugs.

You are welcome!

Any idea why smileys don't work in this platform?

Because doxycycline has been in use for decades now and azithromycin is relatively a much newer antibiotic. Due to the abuse of doxycycline for a much longer time relative to azithromycin the majority of population today is resistant to its antibiotic action. This can be confirmed by performing an antibiotic response test using samples of urine. A popular misconception is that doxycycline works in clearing MG blockage due to it's antibiotic action. The truth is it's not the antibiotic action but the anti inflammatory action that makes the difference.

This is the reason that the standard first line protocol of treatment in MGD is oral doxycycline combined with topical azithromycin.If the antibiotic action of doxycycline was sound enough then azithromycin would not have been necessary. A study also confirmed that when doxycycline was used alone in MGD patients it didn't improve tear parameters like TBUT LLT or OSDI significantly. When azithromycin was used alone on the same group of patients it improved the tear parameters significantly due to the superior antibiotic and anti inflammatory action of azithromycin. When both were used in combination the parameters improved even further which confirms the contribution of doxycycline primarily as an anti inflammatory drug for MGD.

Secondly azithromycin has much superior antibiotic action on the staphylococcus strains of bacteria found commonly in skin and eyes in comparison to doxycycline. So it's definitely not worthwhile to risk the development of resistance to a much superior grade of antibiotic. In this context it is undoubtedly different from doxycycline.

I didn't say azithromycin wasn't safe but I am personally more careful with its use. My doctor refused to prescribe me azithromycin the second time even on my request as she was "saving" it for potential future use.



Again the fact that acne patients have gone >3 months without any SIDE EFFECTS doesn't eliminate the problem of antibiotic resistance. Absence of side effects is just a measure of the safety of the drug. And it's not "unknown" as you write regarding the number of times azithromycin can be used before pathogens develop resistance. Azithromycin becomes less effective after just 5 rounds of administration and is almost ineffective after 7-8 rounds of its use. These are the words coming from my opthalmologist.

Thank you for writing this, couldn’t agree more. Well said. I didn’t understand that difference between the two drugs.

[MGD1701]

Hi Signe
Wise to find out if gland/lashe ducts/orifices are covered by scar tissue or capped, or (years of sticky bacterial) biofilm issue as these needed to be solved first - otherwise doxy might not be effective since you have tried LipiFlow, IPL. Right order does make a big difference. More please read my old post

http://forum.dryeyezone.com/forum/ar...a-tea-tree-oil

[Signe]

Thank you for the answers. I will do some research on Azithromycin and ask my dr. about it.

[MGD1701]

azithromycin
I have read a few reports from professional journals that this is effective and less side-effect as doxy.
I am sure you can easily obtain such info.

However, since you have tried many, maybe there are other issues,
capping, biolfim - then BlephEx etc should help
scar tissue - then probing should help
allergy, demodex (need tea tree oil) etc.

[Milo007]

I actually disagree that Azithromycin should be trump card -- why is it any more different than doxy? Azithromycin is very safe, one of the most prescribed oral antibiotics actually.

Because doxycycline has been in use for decades now and azithromycin is relatively a much newer antibiotic. Due to the abuse of doxycycline for a much longer time relative to azithromycin the majority of population today is resistant to its antibiotic action. This can be confirmed by performing an antibiotic response test using samples of urine. A popular misconception is that doxycycline works in clearing MG blockage due to it's antibiotic action. The truth is it's not the antibiotic action but the anti inflammatory action that makes the difference.

This is the reason that the standard first line protocol of treatment in MGD is oral doxycycline combined with topical azithromycin.If the antibiotic action of doxycycline was sound enough then azithromycin would not have been necessary. A study also confirmed that when doxycycline was used alone in MGD patients it didn't improve tear parameters like TBUT LLT or OSDI significantly. When azithromycin was used alone on the same group of patients it improved the tear parameters significantly due to the superior antibiotic and anti inflammatory action of azithromycin. When both were used in combination the parameters improved even further which confirms the contribution of doxycycline primarily as an anti inflammatory drug for MGD.

Secondly azithromycin has much superior antibiotic action on the staphylococcus strains of bacteria found commonly in skin and eyes in comparison to doxycycline. So it's definitely not worthwhile to risk the development of resistance to a much superior grade of antibiotic. In this context it is undoubtedly different from doxycycline.

I didn't say azithromycin wasn't safe but I am personally more careful with its use. My doctor refused to prescribe me azithromycin the second time even on my request as she was "saving" it for potential future use.

Unknown. Acne patients (also benefit from azithromycin) have gone >3 months without any side effects problem (easy to Google these studies). The fear of antibiotic resistance isn't for yourself, but rather the herd (the general population).

Again the fact that acne patients have gone >3 months without any SIDE EFFECTS doesn't eliminate the problem of antibiotic resistance. Absence of side effects is just a measure of the safety of the drug. And it's not "unknown" as you write regarding the number of times azithromycin can be used before pathogens develop resistance. Azithromycin becomes less effective after just 5 rounds of administration and is almost ineffective after 7-8 rounds of its use. These are the words coming from my opthalmologist.

[deep_dry_eye]

How many rounds of azithromycin do you think would be necessary to develop antibiotic resistance?

I don't think it's wise to use azithromycin before exhausting out other options to control inflammation.

Azithromycin is like a trump card in a dry eye patient's repertoire which should be used only if every other option fails. Also if bacterial overgrowth is the major problem one should rotate antibiotics to prevent development of a specific antibiotic resistance.

Unknown. Acne patients (also benefit from azithromycin) have gone >3 months without any side effects problem (easy to Google these studies). The fear of antibiotic resistance isn't for yourself, but rather the herd (the general population).

I actually disagree that Azithromycin should be trump card -- why is it any more different than doxy? Azithromycin is very safe, one of the most prescribed oral antibiotics actually.

[Milo007]

minocycline and doxy belong to the same class of antibiotics, they should have similar effects. personally i still find azithromycin to be the best (ive tried doxy as well).

How many rounds of azithromycin do you think would be necessary to develop antibiotic resistance?

I don't think it's wise to use azithromycin before exhausting out other options to control inflammation.

Azithromycin is like a trump card in a dry eye patient's repertoire which should be used only if every other option fails. Also if bacterial overgrowth is the major problem one should rotate antibiotics to prevent development of a specific antibiotic resistance.