redhotoz
14th April 2006, 10:36 AM
On Nov 10 last year, this was posted in the RSG about OR. I saved it because it had loads of info in it, incase I ever need it. Touch wood, I don't right now! I vaguely remember Laura saying she had quoted it from a previous post. It's LONG!
"Ocular rosacea is a disorder that affects both the eye surface
and eyelid. Some of the most common symptoms include:
. Bloodshot eyes
. Burning sensations
. Eye pain
. Foreign body sensations of the eye surface
. Excess tearing of the eye
. Hyper-sensitivity of the eye surface
. Eye irritation to wind, cold, smoke, indoor heating
. Photophobia (pain and tearing of the eyes triggered by bright light).
. Itching of the eye surface
. Redness, crusting, and inflammation of the eyelids. In some cases, crust may form overnight that `glues' the eyelids together.
. Chalazia (inflammatory bump on the eyelid)
. Stye (inflammation of an eyelash follicle)
. Excess discharge from the sebaceous glands of the eyelids.
. Loss of eyelashes
. Severe damage to the cornea and blindness
Obviously, there is a great degree of overlap with eye symptoms
from allergies. It is very wise to see an eye specialist. They will run
a thorough series of tests to determine the most probable cause
of your symptoms, and the physician should give you some effective treatment options.
In all simplicity, ocular rosacea is a combination of dry eye and
ocular inflammation. Surprisingly, relieving the dry eye symptoms usually results in substantial improvement of ocular rosacea.
One of the main complaints that occular rosacea sufferers complain
of is blurry vision. In 99% of the cases this actually has nothing to do with vision loss. It has to do with a disturbance in the three layers of moisture on your eye surface (mucus, water and oil).
This (and sometimes the inflammation) plays a role. Good treatment
focuses on getting back a normal tear film layer first, then seeing what
happens.
ARTIFICIAL TEARS are one of the best things you can do for your
eyes. While treatment for ocular rosacea is usually multifactorial,
severa studies have shown that daily use of artificial tears for three to
four months can help the tear film stabilize by decreasing ocular
irritation. Then patients can sometimes stop immediately or just use them
upon flare ups. PLEASE DON'T USE VASO-CONSTRICTOR EYE
DROPS!
The challenge is to find the right eye drop for your eye. The eye
vessels in general are a lot more forgiving then the facial
vessels.
Many folks recommend Refresh Plus Drops for Sensitive Eyes. I
have found great success with Thera Tears eye drops, which are
preservative free.
In many cases, the normal eye drops are not strong enough.
That is why the leaders in the industry have made gel drops. Several of
these gel drops by themselves have been shown to improve the entire
tear film layer, stabilize the water concentration and electrolyte
balance, and reduce some forms of inflammation. Gels last 4 to 8 times
longer than most normal eye drops.
Some of the newer versions of gel drops worth a try are:
1. GenTeal Eye Gel ^ Carbopol 980 gel. This is the strongest gel drop. For flat out moisturization without blurriness, Dr. Nase likes thise new preservative free gel by GenTeal.
2. Bausch and Lomb Liquid Gel ^ Hypromellose gel.
3. Systane ^ hydroxypropyl guar. This is the newest gel
derivative and there is quite a bit of information on pubmed about the guar actions.
Many like the Similasan I and II drops. For those with severe dry
eye, the Lacriserts placed under the eyelid at night still have no
match.
Another good topical for ocular rosacea is an ointment called Lacrilube by Allergan. It is kind of thick and sticky so you won't really be able to use it during the day. It definitely makes your eyes feel better, especially when they have that foreign body sensation or irritation. You put it directly in the pocket of your eyes.
If the inflammation is still severe, Doxycycline 100 mgs 2 to 4 times a day can be used. or Periostat 40 mgs. If this fails, then the mast cell inhibitor Patanol is always a good try.
Two new eye drops/suspensions continue to show promise for moderate to severe ocular rosacea.
1. 10% N-acetylcysteine drops (Mucomyst) -- This mucolytic agent can be used successfully in rosacea patients with abnormal tear film layer (mucus layer). In ocular rosacea, the superficial inflammation can alter goblet cells, which affects the production of the tear film layer. This is the first agent to address this specific problem.
2. Cyclosporine ophthalmic (Restasis) drops -- Used to relieve dry eyes caused by suppressed tear production secondary to ocular inflammation. First eye drop to actually increase natural tear production, stabilize tear film layer and resolve ocular inflammation. Restasis eye drops are available by prescription. It can take up to 3 months to see their full effect.
Oral cyclosporine can cause a number of side effects. Topical
cyclosporine (restasis) should be used cautiously in moderate
to severe occular rosacea patients, but it is generally much safer to
use. Medical studies indicate it may be used safely long term 6 to 9
months with a low side effect profile. In many patients, it relieves the
inflammation and therefore stops the tear film layer from breaking up.
Regarding rosacea, it specifically blocks several classes of inflammatory
cytokines on the ocular surface, which this makes the ocular surface
more "healthy". If you decide to start the eye drops, follow up with
your doctor and get ocular surface testing every 3 to 6 months.
Supplemental help for Dry Eyes & Ocular Rosacea
There are two new oral products on the market for adjunctive
treatment of dry eyes and ocular inflammation. While the web
sites listed below certainly are promotional, they are quite informative
and are consistent with the current medical information on dry
eye syndrome, ocular inflammation, and treatment of both
conditions.
They both utilize essential fatty oil supplementation and one brand has added mucin to their mixture (which theoretically may help support the inner most layer of the tear film - the mucous layer). In addition to daily lid hygiene and eye drop/eye gel therapy, these might be worth a 60 day trial in those ocular rosacea sufferers with persistent problems.
1. Hydroeye Softgels. Claims to:
a. Decrease ocular surface inflammation
b. Stabilize tear film by thickening outer oil layer
http://www.agingeye.net/dryeyes/hydro.pdf
2. TheraTears Nutrition Soft Gels. Claims to:
a. Decrease ocular surface inflammation
b. Stabilize tear film by thickening outer oil layer
http://www.theratears.com/nutrition.htm
Frequent facial flushing causes inflammation of the meibomian
glands, the oil glands in the eyelids. With meibomian dysfunction, the oil
is either too thick or too thin, and does not do its job. An
abnormality in meibomian gland activity is therefore considered a secondary cause of ocular rosacea. This abnormality can take on two forms:
1. A hypersecretion of oil: excessive amounts of oil are produced
The oil is yellowish, and in some cases may take on a
semi-solid form. Excess oil causes inflammation on the eye surface and within the eyelid.
2. a hyposecretion of oil: not enough oil is produced. This
usually results from inflammation or blockage of the meibomian gland
pores.
OcuSoft Lid Scrubs for Sensitive Eyes are recommended for
removing that irritating, sandy debris that some get. Some use baby
shampoo and washcloths to remove this debris.
Another good option is the prescription C-Metron .75;
Metrodianozole for the eyes. Its made at Leiters Pharmacy in San Jose, and has been in the making for several years. Sometimes all one needs to do is close the eyelids and apply the lotion to the outside of the eyelashes.
For chronic blepharitis, some folks like eye cream for lids from
Demodex Solutions (2% metro in it). It helps get calm down
inflammation on the eyelids.
Some Ocular Rosacea Treatment Suggestions
STEP 1: FIND A QUALIFIED PHYSICIAN
1. Search for an Ophthalmologist:
Rosacea sufferers should be examined by medical eye specialists
because ocular rosacea usually presents with multiple symptoms that
may confuse general physicians. Most medical eye specialists(ophthalmologists) are qualified to treat ocular rosacea.
2. Help the Ophthalmologist:
Rosacea sufferers can help their physicians by answering a few
key questions such as:
. Do your ocular symptoms get worse during bouts of facial
flushing?
. Are your ocular symptoms the most troublesome in the
morning, or do they get worse as the day progresses?
. Do you experience blurred vision, eye pain, or vision loss?
. What are your most bothersome symptoms?
. Do you wear contact lenses and if so, what type?
. What medications are you currently taking (include a complete
list)?
STEP 2: BASIC OCULAR THERAPY
The major goals of ocular therapy are to decrease eye surface
inflammation, reduce eyelid inflammation, and normalize the
tear film (oil, water, and mucous layers). As with any disorder, it is
wise to start with the simplest and safest therapies. Most ocular
rosacea sufferers will get significant relief with eyelid scrubs,
artificial tears, oral antibiotics, nutritional therapy, and
elimination of eye irritants. So this is a good place to start.
1. Eyelid Scrubs:
Daily eyelid scrubs are one of the most important parts of the
ocular rosacea treatment regimen. Ophthalmologists who
specialize in ocular rosacea stress that meticulous eyelid hygiene must be
performed daily (and sometimes twice daily) in order to keep this
chronic disorder under control. Proper eyelid hygiene can relieve
most eyelid and eye surface symptoms:
. It removes eyelid crusting, scaling, and microorganisms (yeast
& bacteria).
. It decreases eyelid inflammation, itching, and burning
sensations.
.It increases tear film stability by unblocking meibomian glands
and increasing flow of protective oil.
General physicians routinely recommend that patients use
"home-made" cleansing solutions with dilute baby shampoo to cleanse their eyelids. These "home-made" cleansing solutions work fairly well
on simple cases like dry eye and eyelid crusting, but these
solutions are not advisable for ocular rosacea sufferers. First of all, dilute
baby shampoo causes eye irritation and stinging in many ocular
rosacea sufferers. Second, dilute baby shampoo is not as effective
as ophthalmologist-designed eyelid scrubs. For these reasons,
medical experts strongly recommend that ocular rosacea sufferers use
commercially available eyelid scrubs.
Recommended Eyelid Scrubs for Ocular Rosacea
a. Ocusoft Eyelid Scrub for Sensitive Eyes (Ocusoft
Inc.)
b. Eye Scrub Sterile Eyelid Cleanser (Ciba Vision
Ophthalmics)
Methods for Thorough, Gentle Eyelid Cleansing
. Eyelid Scrubs with Q-tips (cotton swabs). It is highly
recommended that ocular rosacea sufferers apply eyelid scrub
solution onto a Q-tip and gently cleanse their upper and lower
eyelids. Q-tips are recommended because they aid in removing
crust and debris from the eyelid. The eyelid skin is very delicate, so
close the eyes and use gentle side-to-side strokes across the
eyelid margins and lashes, being careful not to rub harshly or irritate
the skin. Patients should cleanse each eye for 30 to 60 seconds.
Lather from the eyelid scrub should then be rinsed off or removed
gently with a tissue. This method is also effective for removing
eye make-up and mascara.
. Eyelid Scrubs with Pre-Moistened Pads. Most commercial eyelid scrubs are also available in convenient pre-moistened cotton pads that are easy to use and lather up very quickly. For those sufferers who cannot safely use Q-tips around the eye, pre-moistened pads are an excellent choice for eyelid cleansing.
. Note: Medical experts stress that eyelid scrubs should become
a permanent part of the patient's routine. Patients should consider
daily eyelid scrubs as important as washing their faces and brushing their teeth. Disciplined eyelid cleansing will make a difference in
ocular rosacea symptoms.
2. Artificial Tears:
Artificial tears are similar to the eye's own tear layer. They lubricate the eyes and help maintain normal levels of moisture. Artificial tears do much more than just add water to the eyes; they also speed up healing of the eye surface, normalize goblet cell activity, and decrease ocular inflammation. Artificial tears are available in many types and brands. When choosing an artificial tear, ocular rosacea sufferers should only use non-preserved products, because preservatives can worsen ocular symptoms.
Artificial Tears Recommended for Rosacea
a. Thera Tears (Advanced Vision Research). This is a
superb eye drop for mild, moderate, or severe dry eye. I highly recommend this eye drop because it is formulated with an electrolyte solution specially designed to protect and nourish the eye surface (Thera
Tears replicated the electrolyte balance of the human tear film).
Recently, Thera Tears has developed a new preservative-free
eye drop that is available in a multi-dose bottle. Thera Tears in a bottle
contains a patented preserving ingredient that turns into pure
oxygen and water upon contact with the eye. Oxygen and water
work with the Thera Tears formula to provide excellent soothing dry
eye relief.
b. Refresh Plus (Allergan). Refresh Plus is a popular
moisturizing eye drop that is available in single use, preservative-free
containers. This eye drop is a good choice for mild to moderate
dry eyes.
c. Hypo Tears Select (Ciba Vision). Hypo Tears Select
is a new moisturizing eye drop that is available in a multi-dose bottle.
Hypo Tears Select contains a patented preserving ingredient that
turns into oxygen and water upon eye contact. This eye drop is
good for mild to moderate cases of dry eye.
d. Similasan #1 (Similasan Inc). This is a homeopathic
eye drop that is used to soothe mild to moderate dry eyes. Similasan also
relieves redness of the eyes and eyelids. Similasan is a
preservative-free solution that contains extracts of eyebright,
honey bee, and cevadillas.
e. Celluvisc (Allergan). This is a thick eye drop that was
developed for the treatment of severe dry eyes. In general, thicker
eye drops are more effective because they are retained on the
eye surface for longer periods of time. For severe dry eyes,
carboxymethylcellulose sodium (the active ingredient in
celluvisc) is a good choice for long lasting coverage and protection of the
eye surface. Celluvisc is available in single use, preservative-free
containers.
f. GenTeal Lubricant Eye Gel (Ciba Vision). This is a
clear gel that liquefies upon contact with the eye, spreading rapidly without
leaving streaks or causing blurred vision. This gel is also preservative free -- it contains a unique preservative that turns into pure water and oxygen upon contact with the eye. Once in the eye, this gel forms a long-lasting protective film. This is an excellent choice for moderate to severe dry eye sufferers.
3. Oral Antibiotics:
Oral antibiotics are very effective at reducing ocular rosacea
symptoms. Oral antibiotics have several important actions in the
treatment of ocular rosacea:
. They stabilize the tear film.
. They improve oil secretion from meibomian glands.
. They decrease eyelid inflammation.
. They reduce eyelid bumps (chalazia and styes).
. They decrease the leakage of inflammatory cells through blood
vessels of the eye.
. They decrease eye surface flushing and inflammation (for
some unknown reason, antibiotics are quite effective against the
vascular symptoms of the eye).
a. Tetracycline Antibiotics. Oral tetracycline is very effective at
reducing the symptoms of ocular rosacea. Systemic tetracyclines
decrease eye surface inflammation, improve meibomian gland
oil secretion, improve the stability of the tear film layer, reduce
aqueous tear film evaporation, and improve the health of the
ocular surface. In most cases, symptom improvement is noted within 4
weeks of treatment (250 milligrams 4 times a day).
b. Doxycycline. Ophthalmologists treat many of their ocular
rosacea patients with doxycycline due to its anti-inflammatory
actions and its positive effect on meibomian glands. Doxycycline
(50 or 100 milligrams 2 times a day) is very effective at reducing
ocular rosacea symptoms, and in some cases may be more
effective than standard tetracyclines.
4. Nutritional Therapy:
The main action of nutritional therapy is to reduce ocular
inflammation. Excess free radicals on the eye surface can cause
eye inflammation by dilating surface blood vessels and disrupting
the tear film layer. Increased oral intake of free radical scavengers
(antioxidants) may play a role in decreasing eye surface
inflammation and preventing damage to surface blood vessels:
(a) Antioxidants that have Anti-Inflammatory Actions in the Eye:
. Ester-C: Ester C is a form of vitamin C that is gentle
on the stomach and highly bioavailable. It is recommended that
rosacea sufferers slowly work their way up to 1,000 to 3,000 milligrams
per day (in divided doses).
. Grape Seed Extract: Grape seed extract is one of the most
powerful antioxidants known to science. It is recommended that rosacea
sufferers slowly work their way up to 150 to 300 milligrams per
day (in divided doses).
. Pycnogenol (pik-no-gen-ol): Pycnogenol has very similar
actions to grape seed extract. It is recommended that rosacea sufferers
slowly work their way up to 50 to 200 milligrams per day (in divided
doses).
(b) Essential Fatty Oils:
. Borage Seed Oil: Supplementation with essential fatty oils such
as gamma linolenic acid, the active ingredient in borage seed
oil, may be beneficial to patients with ocular symptoms. Gamma
linolenic acid (GLA) has two interesting mechanisms of action in the
treatment of ocular disorders: (1) GLA supplementation decreases ocular inflammation, and (2) GLA supplementation increases mucous production from goblet cells, resulting in a more stable tear film layer.
5. Eliminate Eye Irritants:
Rosacea sufferers should be extra cautious when using products around the eye area because they can cause allergic/irritant reactions that may trigger ocular rosacea symptoms. Eye makeup, eyeliners, mascara, under-eye concealers, and cleansers are common triggers for eye irritation. Sunscreens and moisturizers (that run down into the eye) can also irritate the ocular surface.
Hair sprays are problematic for many rosacea sufferers; the hair
spray mist can fall onto the eye surface and disrupt the tear film
layer. Eye experts emphasize that this is one of the worst ocular
irritants for female rosacea sufferers. It is highly recommended
that rosacea sufferers place a wide barrier, such as a hand-held
mirror, between the hairline and eyes before applying hair spray
(placing a hand over the eyes is usually not a sufficient barrier).
Otherwise, many unsuspecting rosacea sufferers are starting off
the day with a disrupted tear film layer and ocular irritation!
Extreme caution must also be given to "Get the Red Out" eye
drops that temporarily constrict blood vessels on the surface of the eye.
These eye drops should not be used by rosacea sufferers
because after the eye drop wears off, surface blood vessels usually
become more dilated and hyper-responsive. Over time, this makes the
ocular condition much worse.
STEP 3: ADVANCED OCULAR THERAPY
Ocular rosacea sufferers who do not respond adequately to
basic therapy (or continue to worsen), will need more advanced
therapy.
Topical antibiotics, topical steroids, topical mast cell
stabilizers, oral isotretinoin, oral antifungals, punctal occlusion,
and photoderm offer moderate to severe ocular sufferers greater
chances for clearance.
1. Advanced Rosacea Therapy - First Tier:
(a) Antibacterial Eye Drops and Ointments:
Some rosacea sufferers have an overabundance of bacteria on
their eyelids. In ocular rosacea sufferers with bacterial infection,
topical antibiotics may help decrease ocular symptoms. Three
popular antibiotic eye drops and ointments are:
. Bacitracin Ophthalmic Ointment (Fougera)
. Ilotycin Ointment (0.5% Erythromycin, Lilly Research
Laboratories)
. Polytrim Eye Drops (Trimethoprim and Polymyxin B
Sulfate,
Allergan)
(b) Steroid/Antibacterial Eye Drops:
Topical steroids should not be used to treat most sufferers with
facial or ocular rosacea. However, in some cases, short courses
of topical steroids may give considerable relief to ocular symptoms
and may help break the vicious inflammatory cycle that often
accompanies ocular rosacea. Topical steroids applied to the eye surface
and/or eyelid margin can suppress inflammation and reduce the
disease to a level that is controllable with standard "safe" therapies. Most
eye experts who use topical steroids to treat ocular rosacea use
a three-day treatment plan to break the inflammation (i.e. steroid
treatment is prescribed two to four times per day for three
consecutive days). This is followed by a 21 to 28 day break from
the steroid. Three of the top steroid/antibacterial combinations
are:
. Blephamide Liquifilm (10% sodium sulfacetamide +
0.2% prednisolone acetate in a microfine suspension; Alcon
Laboratories, Inc.). This steroid/antibacterial liquifilm drop is extremely
effective against eye surface symptoms (inflammation, redness,
hypersensitivity and burning), and eyelid symptoms (inflammation, swelling, crusting, itching and seborrheic dermatitis). Personal
communication with over a dozen ophthalmologists indicates
that this is one of the most effective topicals for the treatment of eye
surface and eyelid inflammation.
Blephamide liquifilm may be applied via two methods:
Method 1: Treatment of the Eye Surface and Eyelid
(1) Tilt head back and apply 1 drop into the eye.
(2) Close the eye and spread excess medication over the full
length of the upper and lower eyelids.
(3) Do not wipe any medication off the eyelids. It will dry
completely within 5 minutes to a clear film that remains on the
lids for several hours - it cannot be seen by others, nor will it
interfere with vision.
Method 2: Treatment of the Eyelid
(1) Tilt head back and with eye closed, place 1 drop onto the lid -
preferably in the corner of the eye close to the nose.
(2) Spread medication over the full length of the upper and lower
lids.
. Tobradex (tobramycin and dexamethasone opthalmic
suspension; Alcon Laboratories Inc.). This is an excellent steroid/antibacterial drop that is used to treat eye surface and eyelid inflammation.
. Cortisporin (neomycin, polymyxin B sulfate and 1%
hydrocortisone; Catalytica Pharmaceutical, Inc). This is an excellent
steroid/antibacterial drop that contains a very weak steroid. It is
a good option for eyelids and eye surfaces that are sensitive to
strong steroids.
(c) Mast Cell Stabilizer Eye Drops:
Mast cell stabilizer eye drops prevent the release of inflammatory
substances from mast cells on the eye surface. Mast cell
stabilizer eye drops may decrease ocular rosacea symptoms by two
different mechanisms; they decrease allergy-related eye inflammation,
and reduce chronic inflammation on the eye surface.
Patanol (olopatadine HCL, Alcon Laboratories, Inc).
Patanol has two mechanisms of action; it blocks histamine receptors and
stabilizes mast cells on the eye surface. This blocks the inflammatory actions of histamine, and prevents the release of half-
a-dozen potent dilators from mast cells. Patanol is one of the
newest topical eye drops that only requires twice daily dosing
(one dose lasts up to 10 hours). More importantly, Patanol starts to
work within minutes of application (unlike most other mast cell
stabilizers that require 4 to 7 days of dosing before they become
effective). Patanol is now considered to be the "gold standard"
for stabilizing mast cells on the eye surface.
(d) Very-Low-Dose Isotretinoin:
In ocular rosacea sufferers with severe eyelid inflammation, eye
surface inflammation, blocked meibomian glands, thick oil
discharge, or recurrent chalazions, very-low-dose isotretinoin usually
results in excellent clearance of symptoms.
Oral isotretinoin has several important actions in the treatment of
ocular rosacea:
. It decreases eyelid inflammation and swelling.
. It unblocks meibomian glands and normalizes thick oil
discharge from these glands.
. It decreases eye surface inflammation by blocking the
production of inflammatory immune cells.
. It treats chalazions and prevents future formation of these
eyelid bumps.
Note: For isotretinoin to be effective in treating ocular rosacea,
it must be used at very-low dosages (10, 5, or 2.5 milligrams per
day). Higher dosages, especially those used for acne, may have
the opposite effect and worsen ocular symptoms.
(e) Oral Antifungals:
Moderate to severe ocular rosacea sufferers with seborrheic
dermatitis may never truly get a hold on their ocular symptoms.
In these sufferers, medical experts recommend taking swabs of
the outer eyelids to examine for fungal infections. Personal reports from
numerous eye specialists indicate that in cases with seborrheic
dermatitis of the eyelids, short courses with oral antifungals can
be a Godsend in reducing ocular rosacea.
The goal of oral antifungal therapy is to decrease seborrheic
dermatitis down to levels that can be maintained easily with daily
lid hygiene and/or intermittent use of topical eye drops such as
blephamide. Three popular oral antifungals are:
. Ketoconazole (Nizoral Tablets, Janssen)
. Fluconazole (Diflucan Tablets, Pfizer)
. Itraconazole (Sporanox Capsules, Janssen)
2. Advanced Rosacea Therapy - Second Tier:
(a) Punctal Occlusion: Artificial tears are the most common
therapy used for dry eyes. Artificial tears are available for the relief of
symptoms but, unfortunately, improvement is short-lived
because the tears drain through the canals in the sides of the eyelids
(puncta).
Conserving the eye's own tears is another approach to keeping
the eyes moist and comfortable. An ophthalmologist can conserve
natural tears by closing the canals via punctal occlusion. This is
analogous to plugging up a bathtub with a stopper; the closure conserves
your own tears and makes artificial tears last longer. Punctal
occlusion is usually considered when artificial tears and systemic
medications do not adequately control symptoms of dry eye, or when eye
drops have to be used very frequently. Punctal occlusion usually results
in dramatic relief of moderate to severe dry eye symptoms.
Benefits of punctal occlusion:
. It improves the tear film layer by increasing the aqueous
component of tear film.
. It improves the tear film layer by normalizing tear film
osmolarity.
. It improves the tear film layer by increasing the number of
mucous-producing goblet cells on the ocular surface.
Punctal Occlusion by Electrocautery. Electrocautery is the most
common method used to permanently close the canals. A fine,
needle-type cautery is inserted into the canals and seals them shut with
gentle heat. To test if punctal occlusion will result in epiphora
(a side effect where tears overflow from the eyes), eye
specialists first touch the cautery against the outer edges of the canal in
order to cause a thin scab to form over the opening. This scab
usually lasts for 5 to 7 days and during this time the physician
checks for adverse side effects. If the patient responds favorably,
he or she can proceed with permanent punctal occlusion (i.e.,
the cautery tip is placed deep within the puncta and heat is then
used to seal the entire canal). Electrocautery is considered to be the
best method for permanent closure of the canals.
Punctal Occlusion by Silicone Plugs. Physicians also offer
reversible methods for blocking the drainage canals. Silicone
plugs can be used temporarily to plug the canals. These plugs give
very good results for several years and can be taken out at any time.
The Freeman silicone plug is currently the most popular brand
among ophthalmologists.
It must be warned that there are two main drawbacks to silicone
plugs (or any other form of insertable plug). First, some plugs
may cause irritation to the eyelid and/or slide deep into the canal and
cause a local irritant reaction. Second, silicone plugs can pop
out within 3 to 12 months.
Important Note on Punctal Occlusion: Inflammation of the eyelid
and eye surface must be under control before punctal occlusion is
performed or else inflammatory substances will stay on the eye
surface for longer periods of time, resulting in more inflammation.
(b) Photoderm Treatment: Photoderm (ESC Medical
Systems) is an intense pulsed light source that treats blood vessels of different sizes, shapes, thicknesses, and skin depths. Recent advances
in Photoderm technology allow the system to safely remove
inflamed blood vessels of the eyelids (note: metal shields must be placed
between the eye surface and the eyelid before treatment to
protect the eye). Eyelid treatment should only be performed by
photoderm experts who have extensive experience with this form of vascular treatment. Patients should not be guinea pigs for well-meaning,
but inexperienced practitioners.
Photoderm can effectively remove damaged blood vessels of the
eyelid, decrease flushing responses in the eye area, and reduce
eyelid swelling (a very difficult symptom to treat by standard
therapies). Photoderm may also normalize meibomian gland
function
by decreasing eyelid vascularity and flushing which have been
implicated in meibomian gland dysfunction.
-Laura"
Hope this helps!
Jen
redhotoz
14th April 2006, 03:11 PM
Oh, and by the way, your'e welcome, in reply to your (lack of) thank you, for the effort I made to reply to your post! In copying it over from the e-mail I had saved, I wanted to make sure it was easily read and spent the time to remove the forward arrows and straighten things out. Ah well, hope it is good info for you none the less.
redhotoz
17th April 2006, 03:03 PM
Hi Chris
This came up a few days ago and the feedback has been good to date. Something very simple for OR:
http://health.groups.yahoo.com/group/rosacea-support/message/82377
"...Here I am, over a year later and virtually cured of this part of the
condition. How did I manage it? Well, I altered the original
suggestion, and took a black wash cloth and dug in the corner of my
eye by my nose. As awful as it sounds, I was surprise to see the
gore that was removed. I did it with the other eye and had the same
results. Literally within the next couple of days of doing that
procedure during the morning shower and in the evening, my eyes
looked and felt tons better. They were regularly moist and the
redness was no different than anyone else. I continued the ritual on
a daily basis and have had ZERO issues with dry eye again over the
past year..."
The idea of a black wash cloth was to simply be able to SEE the "gore" on the wash cloth, nothing special about the colour black. It's in the follow on post from Scott, when he was questioned.
Hope it helps.
Oh, and just to clarify about the long quote I made from Laura, well she did follow up later with this to say on 15 Nov last year: "I didn't write it! Thanks, but I don't deserve credit. It's just lots of notes from other people, mostly Dr. Nase, pasted together and offered to help others. That's what we're here for, to share the knowledge. I try give credit to those who originally wrote the stuff, but sometimes I forget to note their names."
Thought that I should make that clear as all I knew was that I saved that e-mail/post into my OR Folder for future reference.
Jen
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