A question for Dr Justin Bazan

[Rory]

Perhaps dandruff is more substantial and damaging to the tearfilm than everyday dust? But yes it is more likely the condition on the actual eyelids mimicing the scalp sebhorreic condition that disrupts the tearfilm. I will therefore be trying a diluted anti dandruff shampoo very carefully on the eyelids... I shall report back in the next few weeks.....

I have abandoned all nighttime masks goggles etc for the time being...not sure why..but I feel my eyes need to breathe and I do worry that tranquilleyes and masks are more appealing environments for bacteria than my pillow.

[NYer]

Rory,
Not only do I totally agree with what you wrote, but I've been having exactly the same dillema about the shampoo. I've found that T-Gel with coal tar is the only thing that works - and works great - as a dandruff shampoo. But during this discussion, I kept imagining putting that on my eyelid margins and going blind!
I doubt that the dandruff from your head getting into your eyes would be of real concern. After all, flakes from your face and other dead skin cells come off on the pillowcase and if you turn over, those could get into your eyes same as any other junk, like dust or bacteria. And your eyes (should be) closed. I would have to think that simply wearing the Tranquilize goggles would do the trick to prevent that. I mean, you could wear a shower cap but you'd still get other things on your eyelids without goggles.
I'll say one thing, as a group, we know how to look sexy at night: goggles, shower cap, tape over our eyes....whoo hoo!

[Rory]

I very much think that dandruff and blepharitis are directly related.

We all have different causes for our dry eyes and most of us probably have multiple and complex causes. Those that are prone to dandruff....are likely to be experiencing a similar process with eyelashes??

I have always felt that my dry scalp and dry eyes are related... Whilst however the dandruff is easily controlled by anti dandruff shampoos....the eye condition has never been successfully addressed. Recently I have started using sterilid and although I have been doing numerous other things...I believe that this has helped most. It is not however anti dandruff...more anti bacterial. I have never used an anti-dandruff shampoo (diluted) on the eyelid margins...however it makes an awful lot of sense. Preventing as much debris (particularly skin/skin lipids) polarising and disrupting the tearflim is essential? Is this not the source of Dr Holly's dewetting theory?

I currently use T-Gel..Coal tar based anti dandruff shampoo....I would not be too keen to apply this to my eyelid margins..no matter how diluted. I will therefore seek out either selsun blue or another anti dandruff shampoo.

Another concern that I often had ...was dandruff and nightime. If someone has dandruff ..surely this will enter the eyes during sleep from the pillow etc? Would wearing some sort of mask at night help with this?

[Justin]

I like the idea but what happens if it touches your eye?? There are so many warnings about keeping that stuff out of your eye, I'm wondering what will happen if it does get in your eye? Will I explode? Go blind? Eyes burn? Erosion? (OK, I'm done.)

From time to time any shampoo will end up in your eye. I assume that dandruff shampoo will provide you with a similar experience.....some irritation, but no long term damage. I have never prescribed or endorsed this treatment, but I am curious to learn more about it.

[NYer]

I like the idea but what happens if it touches your eye?? There are so many warnings about keeping that stuff out of your eye, I'm wondering what will happen if it does get in your eye? Will I explode? Go blind? Eyes burn? Erosion? (OK, I'm done.)

[Justin]

Dr. Bazan,
Your posts here are immensely helpful. Thank you for taking the interest to take the time and care in your answers that you do. I hope you don't get bored with us. We need people like you here!

Even after the initial flurry of excited postings simmers down, I promise to remain very active and will always address questions posed to me.

I'm very interested in what you said about using diluted dandruff shampoo as an eyelid cleanser.

I was attending a continuing education lecture and the OMD was raving about how a certain type of blepharitis (anterior seborrheic) was positively responding to a careful lash and outer lid margin cleansing with a q-tip dipped in diluted selsun blue. I am not endorsing this. If you like the idea, ask your doc about it. Speaking of bleph....it appears there is an online community for its sufferers. Search here for some more insight. (Sorry I am an Google addict as well!) http://blepharitisforum.com/forum/in...8;sa=showPosts

[Justin]

thanks, Dr Bazan, for another good suggestion - I went out today and got a cool pack to try on my eyelids in between the warm compresses.

Your very welcome, I hope you find some relief. Keep in mind heat is crucial to expressing the glands. After the glands are cleared, some people may find additional relief from the cold. Talk it over with your doc.

I look forward to reading a thread on CVS - I think all of us on here are internet junkies, searching and searching for answers and ideas on how to improve our condition!

I think I have some material posted on my blog, but I think a good start would be http://www.allaboutvision.com/cvs/. CVS is real and very prevalent. Patients everyday are coming to me with issues stemming from staring at a computer all day. It is also a very complimentary specialty to Dry Eye. A lot of overlap.

[NYer]

Dandruff Shampoos for eyelids

Dr. Bazan,
Your posts here are immensely helpful. Thank you for taking the interest to take the time and care in your answers that you do. I hope you don't get bored with us. We need people like you here!

I'm very interested in what you said about using diluted dandruff shampoo as an eyelid cleanser. [This is a very controversial topic, so you may here a few different opinions. Have you tried a foaming lid cleanser? Also inquire about Metrogel.]

That makes so much sense to me, especially after having eye doctors look at my lids under their super duper magnifiers and tell me that they can see dandruff in the lashes. But what concerns me is that all of the dandruff shampoos go out of their way to warn about not getting it into your eyes.

So how do we use it on our eyes without getting it into our eyes? And is there a dandruff "shampoo" made specifically for the eyes?

Thanks!

[eva b]

thanks, Dr Bazan, for another good suggestion - I went out today and got a cool pack to try on my eyelids in between the warm compresses.

I was intrigued by your comment to Stella about not using heat on eyelids which are already inflamed and irritated...perhaps I need to make my compresses a little cooler, although they do bring a lot of relief and I can almost feel the thick meibomian fluid becoming more liquid as the warmth penetrates.

I look forward to reading a thread on CVS - I think all of us on here are internet junkies, searching and searching for answers and ideas on how to improve our condition!

We're certainly lucky that you spend a lot of time online, cos you've provided a number of very useful links for us already!

[stella]

Thank you again Dr Bazen for your prompt and very helpful reply

[Rebecca Petris]

Lastly, if others are using/used claramist, kindly PM me your experience. I have not gathered enough experience with it to make a call on when, how and who to use this with.

Clarymist has several UK fans on the site... a quick search should bring up a lot of their posts. Also you might want to touch base with Tony Barnes who's a member here and I think is a rep of some kind for them - he's been very good about answering questions about it. I do not believe it has an exact equivalent in the US though (I think the Tears Again counterpart is different).

[Justin]

Dear Dr Bazan -Thank you I will try your ziplock method of simultaneous heat and lid massage At present i use steaming as i find moist heat more soothing than dry
Could you recommend an eyelid/margin cream i could use at night please? My lids are sooo dry I have tried lots of things and am allergic to nearly everything i put in, on, or around my eyes
I have blepharitis (MGD) with evaporative dry eyes - probably associated with seborrhoeic (sorry for spelling)dermatitis 'cos i have a real struggle with scalp dandruff and dry areas down the side of my nose and behind my ears which i have to constantly moisturize
I have tried (on lids & margins only) lacrilube ,vasaline , olive oil - all seem to migrate into my eyes causing burning/foreign body sensation/prickle & itch
I had a chalzion and my GP ordered chloramphenical ointment to the lids -- to my amazement it really helped and the cyst went away in a week and i was able to tolerate it I have been using it ever since but tried to stop and got a flare up so have started it again - just the tiniest smear at night after eyelid hygiene.I use claramist in the day - a liposamal spray to the lids containing vits A and E and can tolerate that but it is not greasy enough It helps the DE i think(in place of eye drops)
Can I use the chloramphenical ointment indefinately ? - In GB we have a limited choice eg Erythromycin eye ointment is unavailable.
I also went on a course of doxycillen last yearfor 4 months and it was the first thing that helped me I try to keep that in reserve now if things get really bad . It would seem that antibiotics work for me
Thank you for your help and advise
Stella

Your very welcome. The Bazan Baggy might not be the best thing for you. Bringing dry heat and massage to an eyelid that is dry and irritated will in all honesty probably make it feel and look worse. Proceed with caution.

http://www.cetaphil.com/Products/Default.aspx
Has a good reputation. Is that echoed in the DEZ community?

Have you been evaluated for Rosacea or another masquerading condition like eczema? If you have not seen a dermatologist, I encourage you to do so. http://www.rosacea.org/index.php
Ask your doctors about using diluted dandruff shampoo as an eyelid cleanser. This is a very controversial topic, so you may here a few different opinions. Have you tried a foaming lid cleanser? Also inquire about Metrogel.

I am kind of amazed you are not able to get such a common antibiotic ointment. Call around, and keep in mind the internet has online pharmacies. In the US, tobradex ointment is usually the short term treatment of choice for many eye care providers. The steroid component really aids in the resolution of the typical inflammation associated with the condition.

Chloramphenicol is taboo in the US. I have heard good things from colleagues overseas, but I have 0 experience with it. I am glad you are enjoying success with it.

If the doxy helped you, ask your doctor about nutraceuticals geared to help the long term regulation of meibomian gland function. The doxy was working more as an anti-inflammatory than an antibiotic, the same way a nutritional supplement would work. Dr. Lange would be a great doc to consult with. Remember treating the underlying cause of the MGD is crucial to your success.

Lastly, if others are using/used claramist, kindly PM me your experience. I have not gathered enough experience with it to make a call on when, how and who to use this with. Thanks in advance.

[stella]

Dr Bazon - advise please

Dear Dr Bazan -Thank you I will try your ziplock method of simultaneous heat and lid massage At present i use steaming as i find moist heat more soothing than dry
Could you recommend an eyelid/margin cream i could use at night please? My lids are sooo dry I have tried lots of things and am allergic to nearly everything i put in, on, or around my eyes
I have blepharitis (MGD) with evaporative dry eyes - probably associated with seborrhoeic (sorry for spelling)dermatitis 'cos i have a real struggle with scalp dandruff and dry areas down the side of my nose and behind my ears which i have to constantly moisturize
I have tried (on lids & margins only) lacrilube ,vasaline , olive oil - all seem to migrate into my eyes causing burning/foreign body sensation/prickle & itch
I had a chalzion and my GP ordered chloramphenical ointment to the lids -- to my amazement it really helped and the cyst went away in a week and i was able to tolerate it I have been using it ever since but tried to stop and got a flare up so have started it again - just the tiniest smear at night after eyelid hygiene.I use claramist in the day - a liposamal spray to the lids containing vits A and E and can tolerate that but it is not greasy enough It helps the DE i think(in place of eye drops)
Can I use the chloramphenical ointment indefinately ? - In GB we have a limited choice eg Erythromycin eye ointment is unavailable.
I also went on a course of doxycillen last yearfor 4 months and it was the first thing that helped me I try to keep that in reserve now if things get really bad . It would seem that antibiotics work for me
Thank you for your help and advise
Stella

[Justin]

Also, it's the lids which seem most irritable and where I feel the burning, possibly also conjunctiva - which would suggest some sort of epithelial issue, would it not? The surfaces of the eyes seem to be less troublesome, apart from feeling dry of course. But it's not where the pain is.

I'm glad Stella found this discussion useful as well - I hope some other members do too, then I won't feel guilty about monopolising your time!

thanks again, and regards
Eva

Don't worry about monopolizing my time...remember, many people are just like you and are interested in getting some answers. You are there voice.

Some days I can spend more time online than others. But I can admit to being an internet junkie and will probably post at least every couple of days. Computer Vision Syndrome here I come! Not to hijack the post but, I do have quite an interest in CVS as well. Many of you guys are on the computer as much as me, so if you need some answers let me know.

The underside of your eyelids can quite frequently show a papillary reaction to an irritant. The irritant, causes the typically smooth skin of the underside of your eye lid to become inflamed and bumpy, kinda like sandpaper. This can be a source of pain for some. Ask your doctors about toxic papillary reactions. There are medical ways to treat this, but I hear people find relief in cold packs.

[eva b]

Hi Dr Bazan, and Thanks once again for your detailed response

On the herbal tea front, I only drink caffeine free - I make sure of that!

and yes, your point about strong fragrances is a very good one. Since I've had these eye problems I haven't been using aromatherapy oils (I had to stop working altogether) - you're quite right, strong smells tip me over the edge so no scented cleansers/air fresheners or candles are used in my home. And I use no scented cosmetics or creams...in fact nothing at all on my face for fear of it migrating into the eyes. I have pretty much eliminated all possible sources of irritation that I can, and always wear foam lined goggles when doing any housework.

Thanks for the link to the MCLOSA site - I will certainly get in touch with them and see who is around in the London area.

I am aware of the possible recurrence of the original infection - that was part of the reason for my constant exams last year...none has every been seen, I'm glad to say.
However, I still am fairly convinced that it was the multiple instillation of fluorescein et al that has caused my hypersensitivity, because it is in both eyes, not just the one that had the suspected shingles.

Also, it's the lids which seem most irritable and where I feel the burning, possibly also conjunctiva - which would suggest some sort of epithelial issue, would it not? The surfaces of the eyes seem to be less troublesome, apart from feeling dry of course. But it's not where the pain is.

I'm glad Stella found this discussion useful as well - I hope some other members do too, then I won't feel guilty about monopolising your time!

thanks again, and regards
Eva