Ocular Symptoms Worse While Sleeping

[SolomonCox]

Does anyone else get worse ocular symptoms at night (esp. wake up with a all over red tone to the "white" part of the eyes). What is the reason for this? What can minimize this?

Thanks for any help.

Best of luck to all with their rosacea.
SC

[Melissa W]

Do you experience any other signs/symptoms when you awake?
Is there any itching, burning, tearing or any discharge present at your lid margins when you awake?

[SolomonCox]

Melissa,
Thanks for getting back to me.

Upon waking up, I feel a slight burn sensation on my eyes, and on rare occasions, I get a good amount of viscous fluid on my eyes. About 10 to 15 mins after waking, these symptoms usually disappear.

I have been diagnosed with bleph and have used bacitracin to get rid of my blood shot symptoms. However, I recently had a bout with recurring blood shot eyes that were the result of ocular inflamation. I had to break the cycle using steroid eye drops, which I used for 4 days.

Before sleeping, I usually use Ocusoft wipes. I'm also on low dose accutane, and as a result, have not had much flushing and my presistent redness in my face is greatly reduced. However, my eye symptoms seem to have gotten worse while on accutane.

I really want to find ways to stop the progression and feel that the progression of my ocular problems tend to happen while sleeping.


Any help is greatly appreciated!!! Thanks so much, SC

[Melissa W]

Hi SC,

When you write you have a lot of viscous fluid in your eyes when you wake up do you mean whitish discharge? Or just clear watery discharge?

It's good that you are already doing lid scrubs every night.
Are you instilling any rewetting drops? I recommend (if you don't already) to use preservative free rewetting drops throughout the day. To start I would recommend 6x/day and see how that goes.

I also would suggest using cool compresses upon awaking and a few more times throughout the day to ease any irritation.

http://rosacea-research-foundation.o...Ocular_Rosacea


This link may be helpful about ocular rosacea.

Another area you may want to look into regarding this are supplements that may help ocular rosacea. Omega 3 including flaxseed oil and fish oil has been helpful for some.

I hope this helps and please let me know how you get on.

Best wishes,
Melissa

[SolomonCox]

Melissa,
Thanks for you help again.

I wake up with more of a clear fluid in my eyes. I guess I wake up everyday with it (more than what I would expect a normal person to have), but only rarely does it "overflow". What could be the cause of this (esp since I am already on accutane and my flushing symptoms, at least from what I can tell, have virtually disappeared)?

I currently use "preservative" free eye drops but not nearly as many as you recommend. The eye drops advertise that they are preservative free once the eye drop hits the eye (some chemical reaction I assume makes the preservatives disappear). Is this ok? I use both TheraTears and GenTeal.

Are mast cell stabelizer drops better for long periods of time? What about Restasis?

Lot's of questions for you and I really appreciate your help again,
SC

[Melissa W]

Hi SC,

Why don't you try a preservative free ointment at night right before bedtime. That may help your eyes upon awakening.

Concerning the preserv-free rewetting drops, I prefer the ones that are truly preservative free. They come in single dose units meant to be discarded once opened. These are better because the ones that become preserv-free upon contact may still irritate.

If you haven't tried Restasis I think that's a good idea. I know some people who have ocular rosacea and like Restasis. However, it takes about 6 weeks at least to notice improvement with this so please be patient and continue using the preserv-free drops as well.

It's about trial and error and finding what works best for you. There are lots of options so you are bound to find the best combo for you!

Best wishes,
Melissa

[SolomonCox]

Thanks again. You are very knowledgable about this. Really appreciate you imparting.

I did a search on here for mast cell stabilizers. Didn't find much. Any recommendations and for what symptoms (only allergy related symptoms?)? Any recommendations for long term, recurring usage?

Also, is it bad for rosacea skin to get the no preserve eye drops on skin (as I try to hit the target and often miss; Im so bad at it!!!)?

Thanks,
SC

[Melissa W]

Hi SC,

From the wikipedia:

Histamine dilates post capillary venules, activates the endothelium, and increases blood vessel permeability. This leads to local edema (swelling), warmth, redness, and the attraction of other inflammatory cells to the site of release. It also irritates nerve endings (leading to itching or pain).


Many forms of cutaneous and mucosal allergy are mediated for a large part by mast cells; they play a central role in asthma, eczema, itch (from various causes) and allergic rhinitis and allergic conjunctivitis. Antihistamine drugs act by blocking the action of histamine on nerve endings. Cromoglicate-based drugs (sodium cromoglicate, nedocromil) block a calcium channel essential for mast cell degranulation, stabilizing the cell and preventing release of histamine and related mediators. Leukotriene antagonists (such as montelukast and zafirlukast) block the action of leukotriene mediators, and are being used increasingly in allergic diseases.


Allergic conjunctivitis is inflammation of the conjunctiva (the membrane covering the white part of the eye) due to allergy. Although allergens differ between patients, the most common cause is hay fever. Symptoms consist of redness (mainly due to vasodilation of the peripheral small blood vessels), itching and increased lacrimation (production of tears). If this is combined with rhinitis, the condition is termed allergic rhinoconjunctivitis.

The symptoms are due to release of histamine and other active substances by mast cells, which stimulate dilation of blood vessels, irritate nerve endings and increase secretion of tears.

Treatment of allergic conjunctivitis is by avoiding the allergen (e.g. avoiding grass in bloom during the "hay fever season") and treatment with antihistamines, either topical (in the form of eye drops), or systemic (in the form of tablets). Cromoglicate is sometimes used topically. Azelastine is available as a nasal spray and eye drops.


From Web MD:
Mast cell inhibitors
Cromolyn sodium (Nasalcrom, Crolom) is used to prevent allergic symptoms like runny nose or itchy eyes. Cromolyn sodium must be started 1-2 weeks before pollen season and continued daily to prevent seasonal allergy symptoms. The response is not as strong as that of corticosteroid nasal sprays.



How mast cell inhibitors work: These drugs prevent the release of histamine and other chemicals that cause allergic symptoms from mast cells when an individual comes into contact with an allergen like pollen.
Who should not use these medications: Individuals who are allergic to any components of the nasal spray or eye drops should not take mast cell inhibitors.
Use: Frequent dosing is necessary, since the effect only lasts up to 8 hours. Mast cell inhibitors are available as nasal sprays to prevent runny nose or eye drops for itchy eyes.
Drug or food interactions: Since these drugs have little or no effect beyond the area applied, they are unlikely to interact with other drugs.
Side effects: Contact lenses should not be worn if using eye drops. Eye drops may cause stinging, burning, redness, and, possibly, severe swelling of eyes. Nasal congestion, sneezing, itching, nosebleeds, and burning have been reported with use of cromolyn sodium nasal sprays.

Then there's Patanol or Pataday which some have success with treating their ocular allergies. The following is from the wikipedia:
Olopatadine hydrochloride is an antihistamine and mast cell stabilizer, sold as a prescription eye drop (0.2% solution, trademark Pataday (or Patanol S in some countries), manufactured by Alcon). It is used to treat itching associated with allergic conjunctivitis (eye allergies). Olopatadine hydrochloride 0.1% is sold as trademark Patanol (or Opatanol in some countries).

It should not be used to treat irritation caused by contact lenses. The usual dose for trademark Pataday is 1 drop in each affected eye once a day. The usual dose for trademark Patanol is 1 drop in each affected eye 2 times per day, with 6 to 8 hours between doses.

Here is a summary I posted in another thread a while ago:

Patanol is for allergy eyes and most itchy eyes are caused by allergens like pollen, dust, mold, pet dander etc.

It falls into the antihistamine category:
Antihistamines. Medications that attach to histamine receptors, preventing the chemical histamine from triggering symptoms of an allergic reaction. This helps keep the blood vessels in the eye from swelling. They also relieve eye itchiness and redness. Eyes drops have a quicker onset and cause less drying of the eye than oral antihistamines. Antihistamines are available in both over-the-counter and prescription forms. Examples include:

Azelastine (Optivar)
Emedastine (Emadine)
Ketotifen (Zaditor)
Levocabastine hydrochloride (Livostin)
Olopatadine (Patanol)
Pheniramine (Opcon-A)

Elestat is also in this category:
Epinastine ophthalmic solution is used to prevent itching of the eyes caused by allergic conjunctivitis (a condition in which the eyes become itchy, swollen, red, and teary when they are exposed to certain substances in the air). Epinastine is in a class of medications called antihistamines. It works by preventing the release of natural substances which cause allergic reactions in the eyes.


Then there are the following categories of other meds that may help relieve itchy e

Decongestants. Shrink blood vessels in the eyes that are swollen because of exposure to an allergen. This decreases eye redness, reduces the production of fluid inside the eye and increases the amount of fluid that drains from the eye, alleviating watery eyes. Decongestants are available in both over-the-counter and prescription forms. They should not be used for more than a few days, as overuse of decongestants can trigger a “rebound effect” that actually makes symptoms worse. Examples of decongestants include:

Naphazoline hydrochloride (Allerest, Vasocon)
Tetrahydrozoline hydrochloride (Eyesine, Murine Plus, Visine)

I'm not a big fan of these because of the rebound effect.


Antihistamine/decongestant combinations. Combine the efforts of antihistamines and decongestants. These are available over-the-counter. Examples include naphazoline/pheniramine (Naphcon-A, Opcon-A, Visine-A).


Nonsteroidal anti-inflammatory drugs (NSAIDs). Inhibit the body’s ability to produce chemicals called prostaglandins, which are released during an allergic reaction. Anti-inflammatories reduce eye pain, itching and swelling. They are available by prescription only. Examples include ketorolac (Acular) and nepafenac (Nevanac).


Corticosteroids. Decreases inflammation during an allergic reaction by mimicking the behavior of cortisol, a hormone in the body that aids proper body function during stressful situations. They are only available by prescription. Examples include:

Prednisone acetate (EconoPred, Pred Forte)
Loteprednol etabonate (Alrex, Lotemax)
Fluorometholone (FML)

Again, not the best for rosaceans except for very limited use when very severe symptoms occur.


Mast cell stabilizers (MCS) and MCS combination drops. Strengthen the mast cells to prevent them from releasing histamine and other chemicals that contribute to the symptoms of an allergic reaction. Mast cell stabilizers also reduce eye redness and wateriness. They are available in both over-the-counter and prescription form. Examples include:


Olopatadine hydrochloride (Patanol)
Ketotifen (Zaditor)
Azelastine (Astelin)
Pemirolast (Alamast)
Emedastine (Emadine)
Ketotifen (Zaditor)
Cromolyn (Crolom)
Lodoxamide (Alomide)
Nedocromil (Alocril)

I got most of this info from Dr. Razavi's good to know info.

Lastly, I really like frequent use of preservative-free rewetting drops for itchiness as well as dryness. It flushes your tear film of any irritating debris that may contribute to overall itchiness. I can't state this fact enough. It's all natural and may prevent the need for other meds if used enough.

Again, not sure if that's the type of info you need but hopefully it will give you a place to start. There is a lot of info in the archives regarding ocular rosacea in addition to the links I gave you earlier. Hope this helps!

Best wishes,
Melissa

PS I think it's fine to get the preserv-free drops a bit on your face as you're instilling them into your eyes. There's nothing in them to irritate your skin(no preservatives). Of course, as with everything pertaining to rosacea there are always exceptions but I don't think it should be a problem.

[SolomonCox]

Melissa,
You have been enormously helpful. I genuinely appreciate the time.

Sincerely,
SC

[Melissa W]

My pleasure.
Good luck and let us know how you are doing.

All the best,
Melissa