is this the correct tx for me?

[yoganut]

Hi Dr. Bazan:
I'm 41, had DES diagnosed for about 1 year. For 2 years before my eyelid margins would get extremely itchy at night and sorry to say would be scratching away at them. An opth gave me Fougera FML (?) ointment to apply at night and it went away. Last year I wore my contacts (only wore very occasionally up to then) all day every day while on vacation and 2 weeks later developed what I thought was an eye infection, looked like pinkeye plus painful and lots of stringy mucous. Since then I've been on lotemax on and off and Restasis for about 6 weeks but then went off it.

Since then tried various tx as suggested on this board, rice baggy (left my eyelids dry and inflamed) fish oil (broke me out in huge cysts) and lid hygiene (occusoft and sterilid). Switched opths and my new one has put me on Restasis and lotemax x4 per day, so far its been 3 days and no relief, I really thought the lotemax would start working on the inflmmation, perhaps the Restasis is counteracting it though?

I did ask him in my exam if I have occular rosacea or clogged meibomian and he said no to both, - what good would doing warm compresses and lid hygiene do in my case? The only good thing about being on Lotemax the past 3 days is my eyelids no longer itch like they did and my eyeball isn't stuck to my eyelid when I wake up like it used to. Sorry for such a long post, this new opth of mine is ok, he claims to have dry eyes but even so I do not feel like he is very interested in my condition.
many thanks. Also... today after inserting Restasis and lotemax (1 hr apart) my right eye (the 'troublemaker') got really red, I had some Pataday that I applied... is this ok to do with the other eye drops? many thanks.

[Justin]

Hi Dr. Bazan:
my eyelid margins would get extremely itchy at night

Please tell us more. At night in bed? Regardless of whereabouts (home or away). Has allergy been ruled out?

Since then I've been on lotemax on and off and Restasis for about 6 weeks but then went off it.

Why was the Restasis discontinued?

Since then tried various tx as suggested on this board, rice baggy (left my eyelids dry and inflamed) fish oil (broke me out in huge cysts) and lid hygiene (occusoft and sterilid).

What was the rice baggy made of? What was your experience with the lid care? What was the source of fish oil? All of these symptoms make me suspicious of an underlying allergic theme.

Switched opths and my new one has put me on Restasis and lotemax x4 per day, so far its been 3 days and no relief, I really thought the lotemax would start working on the inflammation, perhaps the Restasis is counteracting it though?

What kind of inflammation are you referring to? Location? What did you and your doctor determine as a treatment plan? goal? At this point a clear clinical picture of your condition elludes me.

I did ask him in my exam if I have occular rosacea or clogged meibomian and he said no to both, - what good would doing warm compresses and lid hygiene do in my case?

Hot compress, lid cleansing and gland expression is something that can be done to maintain optimal meibomian gland function.

Also... today after inserting Restasis and lotemax (1 hr apart) my right eye (the 'troublemaker') got really red, I had some Pataday that I applied... is this ok to do with the other eye drops? many thanks.

Is the Pataday part of your treatment plan? In the short term, the pataday offers little value to an eye already being dosed 4x/day with lotemax. I feel it is always best policy to never self medicate. Always ask your doctor first.

At this point, I would really like you to talk to your doctor again to get a clear understanding of what he thinks is going on with your eye, what the treatment plan is and why he is prescribing it, and what to expect. I still feel we have a lot of the pieces of the puzzle, but we are trying to solve it without using them all!

[yoganut]

Hi Dr. Bazan:
my eyelid margins would get extremely itchy at night

"Please tell us more. At night in bed? Regardless of whereabouts (home or away). Has allergy been ruled out?"

In the evenings before going to bed. Mostly at home but can occur outside.
Since then I've been on lotemax on and off and Restasis for about 6 weeks but then went off it.

"Why was the Restasis discontinued?"
didn't see any improvement in 6 weeks. Eyes felt even more sore during the day while using it. Make the skin round my eyes itch and get red and flaky.

Switched opths and my new one has put me on Restasis and lotemax x4 per day, so far its been 3 days and no relief, I really thought the lotemax would start working on the inflammation, perhaps the Restasis is counteracting it though?

"What kind of inflammation are you referring to? Location? What did you and your doctor determine as a treatment plan? goal? At this point a clear clinical picture of your condition elludes me."

It does me too! Opth never said whehter I have posterior blepharitis or MGD or whatever. I told him I applied warm compresses, which made my eyes puffy and sore and he then said well 'don't do that'. He basically said as a treatment plan, Lotemax and Restasis, Lotemax will subue inflammation while Restasis starts working.
"Is the Pataday part of your treatment plan? In the short term, the pataday offers little value to an eye already being dosed 4x/day with lotemax. I feel it is always best policy to never self medicate. Always ask your doctor first."

Doc gave me a sample of Pataday on my first visit, when I went back he asked me if I used it, I told him a couple of times didn't seem to make much difference to my itchiness. I then noticed the sample was expired.